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After a particularly grueling and unforgiving shift, Robby made his way to the roof of the hospital. Staring out at the sky and watching the day slowly surrender to night always helped ground him. The fabric of his jacket wavered in the breeze, the fresh air feeling nice and cool against his skin.
Robby’s eyes unfocused, and the multitude of negative emotions that he had been tamping down for the last twelve hours began to resurface. Guilt, anger, hopelessness, grief, numbness… you name it, he felt it. They all sat heavy and cold in his chest, the pressure squeezing the air from his lungs. The muscles in his esophagus strained against the amalgamation of feelings that formed a lump which refused to be swallowed down.
Losing your first patient as a MS3 or MS4 -- or as an intern, if you were lucky -- was the worst feeling in the world, even if that patient had no chance of making it out of the ED in the first place. Robby would never forget that feeling. The guilt and sorrow that followed was all-consuming. You couldn't eat regularly or sleep normally for days, and all you thought about were the “what ifs”.
What if I ordered that CT earlier? Maybe I would've caught the bleed in time and they’d still be alive.
What if I had checked on them more in between my other patients? Then I would've caught the cardiac arrest sooner and maybe they would've had a chance.
What if I checked their labs again? I know it’s rare, but the results could’ve been a false negative.
Even now, losing a patient as an attending physician, Robby would sometimes find himself falling down the illogical albeit tempting rabbit-hole that was the “what if” game. On the one hand, looking back at the steps you took -- or didn't take -- meant that you would be very unlikely to make the same mistake again in the future. On the other hand, the “what if” rabbit-hole had a high risk of becoming a slippery slope to endless guilt and despair the longer you ventured down it.
Nurses, medical students, and interns are told that once you’re able to move past losing your first patient, the succeeding losses wouldn’t hit you quite as hard. Robby supposed that was partially correct; now you knew how it felt, and now you generally knew what to expect when it would, inevitably, happen again.
But moving on to your next patient and having to act like nothing happened right after telling someone’s family that their loved one has died?
Pushing your own feelings aside until you had a moment alone to process them, if you ever got one?
That overwhelming, crushing feeling of resignation that overtook you when the time of death was called?
Logically knowing you did everything you possibly could, but feeling like it was never enough?
Those things always hit hard. In fact, the more you experienced those things, the harder they usually hit you.
Today and its losses were weighing especially hard on Robby. Though there was no MCI, they almost rivaled those of PittFest. Death after death after death... Robby had lost almost as many patients as he had fingers to count on by three o’clock. None of them were preventable, but even so, it was really hard not to spiral and play the “what if” game.
Once in a blue moon, on days like today, the ED would get a “streak” of patients that had little to no chance of survival no matter what was done. These streaks almost always followed a good day. Well, a good day by their standards, anyway.
It was almost like the universe was seeking some sort of cruel balance… like it was trying to even the score. More today to make up for yesterday.
Robby stopped trying to make heads or tails of the “fairness” of losing patients long ago. Whether a patient’s death was a coincidence or destiny didn’t make any difference in how hard it was to carry.
Robby did his best to blink away the tears that began to form, his eyes stinging as the floodgates threatened to open despite his efforts. He folded his arms over his chest and rested his elbows on the railing, forcing his attention on the sky as a distraction.
The warm reds and oranges of the sunset had dissolved into deep, cool blues and purples, giving way to the slow ascent of the full moon that had just emerged over the horizon. The early moonlight filtered through the leaves of the trees and danced around the corners of the tall buildings below, casting soft irregular shadows on the pavement and asphalt.
The solid click of a door was heard from behind, drawing Robby out of his own head and back to Earth. A voice was quick to follow it, one that he recognized immediately.
“Thought I might find you here, brother,” Jack called out in a warm greeting. Despite his insurmountable physical and mental exhaustion, a smile tugged at the corners of Robby’s lips.
Jack sidled next to him, leaning against the railing in the same manner. The former’s elbow brushed against Robby’s, the contact a warm anchor to the present. Jack’s gaze followed Robby’s to look at the expanse of the city below and ahead of them.
After a moment, Jack’s eyes flitted to Robby and then back to the Pittsburgh skyline. “Rough day?”
Robby shook his head and choked out a mirthless laugh. He kept his eyes trained on the horizon, resisting the tears that were one sudden movement away from escaping his control. “Yeah, rough day.”
Jack hummed, thoughtful and nonjudgmental. He let the silence sit between them for a few beats, extending a wordless invitation for Robby to talk about it if he wanted to.
Robby cleared his throat, casting a quick glance at Jack over his left shoulder. “Lost a lot of patients today. I lost… eight, by three o-clock.”
Jack scanned Robby’s face up and down, the earnest understanding in his eyes failing to conceal the layer of concern underneath.
Robby continued in a murmur. “Saved a few, but… I always lose more patients than I save.”
Jack hummed again, brushing against Robby’s elbow with his own. It was gentle but noticeable enough for the latter to know that it was on purpose. “Sure feels like that sometimes, doesn't it?”
“Feels like that all the time. It…” Robby sighed. “It’s hard to feel like you're actually saving lives when you put all you can into every patient and still lose them anyway.” Jack nodded knowingly, slow and solemn.
“They were all young, too. Late 20s, early 30s.” Robby’s voice wavered, his vision swimming. “Their lives barely started and now they're over.”
“My last patient today, she just turned 31.” Robby swallowed. “Hypovolemic shock. Didn’t make it.”
“She was in a car accident. A semi driver t-boned her side of the car going eighty miles per hour. She would’ve died on impact if she didn’t try to swerve out of the way.”
Robby let his head hang, his eyes dropping with it to stare at his clasped hands with vacant eyes. “Multiple crush injuries tore through major blood vessels. We just couldn’t get ahead of the blood loss.”
“She had a ring on her left hand. She was married, or at the very least engaged. Her wallet had a picture of her and her husband or fiancé tucked behind her driver’s license.”
A breath stuttered in his chest and knocked a few tears loose. “It’s not fair.”
Jack inched closer, softly shaking his head. “No, it’s not.”
“We did what we could, but,” Robby scoffed, incredulous. “Some- some asshole ran a red light, and now a 31-year-old woman is dead.”
Jack gave another solemn nod and pressed his lips into a thin line. “Awful.”
“Life is short enough as it is,” Robby finished in a mutter, glancing at Jack. The latter mumbled a wordless agreement, frowning when Robby sniffled.
Jack rested his head on Robby’s shoulder, the contact melting the tension that had been building there. Robby leaned his head against Jack’s, pressing a silent kiss to the top of his head. They both turned forward to watch the moon climb higher in the sky, their surroundings darkening bit by bit to reveal the stars.
Robby felt himself relax more with each second that passed. He had no idea how he ever managed to survive this job before Jack came into his life. No matter how shitty his day was, no matter how many patients he lost, no matter what happened, Jack was always there.
Whatever Robby needed, Jack provided. No hesitation, no questions asked. It could be advice, a pep talk, a wake-up call, some help with a particularly tricky case, or to just sit in silence after a rough shift.
Robby was never one to ask for help, but he never had to with Jack. Jack always seemed to know what he needed and when he needed it, usually before Robby even knew anything was wrong in the first place.
After shifts like these, shifts filled with unrelenting and brutal reminders of his own mortality and the brevity of human life, he always held Jack a little closer. Jack was the strength behind him wherever he went, his solid ground. They kept each other sane, they kept each other alive. Robby didn’t know where he would be without him, and he honestly didn’t even want to think about it.
Robby shifted his weight from one leg, to another, and back again in attempts to alleviate the ache in his feet from standing and moving all day. He then remembered the small velvet box that had been sitting in his pocket, and decided that he had waited long enough.
“Jack,” Robby called, his voice just above a whisper.
Jack blinked to pull his focus away from the city below and leaned his head back enough so his eyes met Robby’s. “Mike.”
“I love you.”
Jack smirked, fond and smug. “I know. I love you, too.”
Robby exhaled, long and slow. “I have… no idea what I would do without you.”
“Die, probably.”
Robby chuckled, the sound genuine and bright. “Yeah, probably.”
After their combined laughter faded, Robby continued. “No, really, you… You keep me sane. Despite all the… death, and carnage, and trauma, you help me remember what I’m doing all this for. What I’m-” He swallowed. “What I’m still here for.”
Jack lifted his head, turning to face Robby properly. His expression was dripping with fondness, his eyes half-lidded and warm. A light shade of pink spread across Robby’s cheeks, his breath catching in his chest at the sight.
“My whole shift was packed with… horrible, horrible shit,” Robby muttered, bitter. He shook his head and glanced down to his feet. “Lots of awful reminders that life is never as long as you expect it to be.”
“No matter what kind of shift I have, no matter what’s going on in my life, you’re always there for me. And I can’t even begin to describe how grateful I am for you, Jack.”
“We’ve gotten each other through so much, and we’ve come so far, and I- I can’t imagine my future without you in it.” Robby’s heart started to hammer away in his chest as realization made its way across Jack’s face.
“So,” Robby pulled the small black box from his pants pocket and got down on one knee. “I’m asking you to not make me think about that.” Jack snorted, sniffling as his eyes began to glisten with tears.
Robby flipped open the box, revealing two thin silver engagement bands. One for each of them. “Jack Abbot, will you-”
“Yes!” Jack cut in, the word resounding across the rooftop. “Yes, yes, yes, fuck yes.”
“Yes?” Robby echoed, breathless and hopeful. “You’ll marry me?”
Jack barked a tearful laugh and shook his head in awe. “I will absolutely marry you, are you kidding me? Gimme the ring right now.”
“Alright, alright,” Robby grinned, unable to contain his joy. “Don’t gotta tell me twice.”
He reached around Jack’s neck, slipping the band on the same keyring that held his dog tags. Jack did the same with the other band, unclasping Robby’s Magen David and sliding the ring down the chain.
Robby tucked Jack’s dog tags under his scrubs, moving his hands from the latter’s neck and up to his cheeks. Jack melted into the touch as Robby swept away a few stray tears with his thumbs.
“Hopefully those are happy tears, Jack,” Robby quipped with a fond smile, his hands migrating to Jack’s waist. When they landed there, the latter draped his arms over Robby’s shoulders. “You’re stuck with me forever now, you know.”
“God, I love you,” Jack chuckled, softly shaking his head. He interlaced his hands behind Robby’s neck and pulled him forward, his nose brushing against Robby's cheek as their mouths fell together.
Their bodies pressed close, and Robby could almost feel the beat of Jack’s heart beneath his scrubs. Robby could feel the soft tickle of Jack’s breath beneath his nose, and he could faintly taste the break room coffee on his breath. Warmth blossomed in Robby’s chest as their lips moved in tandem, a blissful call-and-response.
They pulled away after a moment, the both of them misty-eyed. Jack separated his hands and traced them down Robby’s shoulders and arms, taking the latter’s hands in his.
“As much as I don’t want to, I should probably get down there,” Jack pouted and jerked his head to point at the door behind them. “Come with me, I’ll walk you out.”
Robby kissed the back of Jack’s left hand as he unlinked the other. “Thank God we both have double days off after today.”
Jack smirked, giving Robby’s right hand a squeeze as they made their way into the elevator. “Plenty of time to celebrate.”
Robby cackled as the elevator hummed and began its slow descent to the ground floor. “Oh, celebrate, huh?”
“I have some ideas I think you might enjoy.”
“Well, we’ll see if you’re still standing after your twelve-hour shift first.”
“Good point.”
“Hey, there’s always tomorrow.”
“Alright, it’s a date, then.”
The door to the elevator slid open, revealing the hustle of handovers from day shift to night shift. After acclimating to and enjoying the peace and quiet on the roof, stepping back into the perpetually noisy ED was always a bit jarring.
Jack crossed the threshold first, pulling Robby close behind him. Their intertwined hands swung gently back and forth with each step as they made their way through the hospital. Robby gave Jack’s hand a squeeze and the latter shot him an affectionate smile.
They stopped at the threshold of the hospital’s exit, Jack placing his free hand on top of Robby’s hand that he was already holding. “See you when I get home, yeah?”
“Yeah,” Robby nodded, giving Jack’s hand another squeeze before releasing it. “See you in the morning.”
Robby’s and Jack’s postures both deflated a bit as someone shouting the latter’s name could be heard from just outside of North 7.
“Well, fun’s over,” Jack sighed, giving Robby a quick peck on the check before stepping back to grab a tablet from the nurse’s station. “Get home safe, okay, Mike?”
“Oh, you know I will,” Robby replied as he took a few backwards steps towards the door. “I’m not planning on coming back here until Tuesday.”
Jack nodded once and smirked. “Good, no fiancé of mine’s gonna be a patient in my ED!” He pointed at Robby as he called out after him, the latter making his way to the exit and the former making his way to North 7 to help with his first patient of the night.
Heads from every corner turned at the sound of the word “fiancé”, all staff eyes darting from Robby to Jack, Jack to Robby, Robby to Jack. Robby felt his face heat up as most of said eyes followed him to the door.
Robby turned his back to the ED and raised a hand to wave behind him. “Good night! You behave yourself, Jack!”
“No promises!”