Chapter Text
September 6, 2024
5:24 PM
“I just felt like I could never go back after that,” Jack said. He sat forward, elbows propped on his knees, staring at his own folded hands and feeling completely disconnected from them. With his face down he reached for the paper cup of room temperature water on the IKEA coffee table in front of him, his therapist across the room shifting in his seat, likely gearing up for whatever intense direction this conversation was headed in.
“Never go back to work?”
More like never go back to a hospital. “Mhm,” he hummed, taking a sip of water. Somewhere distant in the back of his skull the flatline tone still rang, uninterrupted since this morning. Even in his disjointed post-shift sleep it was the soundtrack of his many fever dreams, all taking place in the hospital, all another episode of someone’s heart stopping underneath his palms as he attempted to push life into their stiff, clammy chest.
“Have you put more thought into a career change since the last time we spoke?”
Jack leaned back into the couch and rested his hands behind his head. “I think switching to another line of work would make it feel worse. These things happen anyway. People go through war and put their lives on the line every day and then come home and get hit by a car. Kate…” Jack swallowed, fiddling with his wedding band behind his head, which he never meant to do but consistently always did when he spoke about her. He fixed his gaze to the setting sun through the window. “Before she got her office job, Kate worked on oil rigs. She would be out there for weeks. Those things are some of the most dangerous places to work. I mean, they’re like bombs the size of the Eiffel Tower.”
That got a laugh from his therapist. He wondered if Tom did that just to make him feel better or if he truly found him funny. Jack liked the thought of entertaining his therapist, in a way. Which was not the point of therapy but maybe it somehow helped him.
Jack sighed. “And then she died doing something millions of women do a year.”
He couldn’t see the hospital from here–some taller buildings blocked the view from Tom’s fifth floor office–but he knew exactly where it was. It was less than ten blocks away. He wondered if he should look for a therapist further from the reason he needed one in the first place.
“It just happens, and I know that,” Jack continued. He smiled, just a little, amused at the sudden image of him being some kind of professor or pharmacist or lab technician. It felt too out of character for him. “Going into another line of work–if that was even possible this far into my life–wouldn’t change that. At least being at the scene of these tragedies makes it feel like I tried to stop them. Leaving this job behind would feel like walking away and giving up.”
“Like you’d just be one less person to try and stop all the death in the world?”
Jack perked up. “Well, when you say it like that, it sounds stupid.”
“It’s not stupid. It makes sense. The problem is that, on the other hand, being there and being unable to prevent tragedy, when that’s what you expect of yourself, may lead you to feel responsible when you’re not.”
Jack took a deep breath. He tried to sit with that. It was never easy to keep himself from taking the blame upon the death of a patient.
This morning, after Jack had called time and fled the room, Parker followed him into the stairwell on his way to the roof. He was meaner to her than he’d meant to be, offended that she saw him sniffling and wiping a tear from his eye, but she didn’t seem fazed.
Our job is to do our best to save people, she said, standing a few stairs below him. If we aren’t there to save people, they have no chance. We give them a chance. It has nothing to do with why they end up here in the first place. You did what you could. You did more than most people in the world could. You can’t let this get to you, man. You’re a great doctor, and you feel this way about it because you care that much, and there’s no way in hell you wouldn’t have done something if there was anything to be done. Give yourself some time. Go home, get some sleep.
When she left the stairwell he went straight to the roof. But Tom couldn’t know that.
“I can’t prevent every bad thing. I can’t stop strong people from stupid deaths,” Jack said.
Tom nodded slowly, tapping his fingers on the arm of his chair. He shifted again, sitting up.
“But does that make it feel any better?” he said. “Is it enough to simply know that, to simply accept that as a way of life? In other words, are you coping with it? Are you actually interacting with this fact of life and processing it, letting yourself feel the magnitude of it, or is it just something you say to yourself to push past it and ‘move on’?”
Jack sat forward, elbows back on his knees, letting out a long exhale through his nose. He shook his head. “I don’t know. I don’t know.” Jack couldn’t tell if going to the roof was his way of avoiding his reaction to tragedy or facing it. Obviously it couldn’t be good, though, that he ever felt the need to do that, let alone multiple times in his career.
“Look, Jack,” Tom said, adjusting his glasses. “You have dealt with a lot of tragedy, more than the average person. You have been at war. PTSD, which you’ve been diagnosed with, is different for everyone, but it’s certainly common that we see individuals with PTSD struggle in their daily lives when their day-to-day involves reminders of their trauma. There is a strong connection between your experiences in the battlefield as a medic and your experiences in the emergency room as a doctor, mainly in the way you are given limited resources and limited time to deal with unexpected traumas of any scale. You must ask yourself if it’s worth it. We’ve discussed how you feel the need to make up for what you may have contributed to overseas, to the violence that you may have been a part of, even if not directly. But the people here, in Pittsburgh, are not the people in Iraq or Afghanistan. You are not giving back to affected civilians in the Middle East. You are doing this for yourself, which you have the right to do. But, still, if you want to do penance and combat your guilt, it will not help to exhaust yourself and try to control what you cannot control. So as you continue to work in the type of environment you work in, you must ask yourself if you are truly being fulfilled, if the pendulum swings more toward life satisfaction than reminders of your trauma or possibly additions to it.”
Jack nodded slowly. He’d spent all of Tom’s monologue staring out of the window. Every session came down to this same conversation. His guilt and his questionable attempts to quell it that never really worked.
After a long gap of silence, Tom flipped through his notebook. Jack wondered what notes he kept of him in there.
“So, Jack, what else is going on these days?”
Jack snorted. The answer was nothing. An empty apartment with an empty dog bowl for the pitbull he never got around to adopting. No new TV shows, even. He was rewatching Succession.
But before he could answer, his phone buzzed on the coffee table. The only people to ever call were his sister and her daughter in med school; combined, both reached out maybe three or four times a year. He had a feeling he knew what this was before he turned the phone over.
PITTSBURGH TRAUMA MEDICAL CENTER.
“One sec,” Jack said. Tom set his notebook on his lap and reached for his water bottle, staring at Jack as he tapped the green pick-up button and brought the phone to his ear.
It was Dana, of course, with news of a mass shooting at PittFest, of course, asking for him to come in as soon as possible, of course. Tom’s eyebrows went up, bottle hovering over his mouth.
“I’ll be there in five,” was all Jack said. He grabbed his jacket and let himself out, telling Tom he’d text him about scheduling the next appointment. Depending on how this went, it might have to be soon.
-
7:09 PM
“That was incredibly fast,” Dr. Mohan said when he finished the crike. Jack looked up at her, not expecting praise for a skill that would have been considered basic training for a battlefield medic. But when he saw the small audience that had accumulated around him and their patient, a cop with a GSW to the right cheek, he felt a little bashful, a little shy. He’d never expected to feel good at any point during a mass casualty event, and here he was, warm and fuzzy.
He glanced briefly back at Mohan, who had a particular twinkle in her eye, seemingly unfazed entirely by the pools of blood on the floor and the gunshot victims crying out across the ER, or the body being wheeled past, white sheet over their head and a dried reddish-brown stain where their face should’ve been. Her voice had penetrated the flatline tone stuck in his head.
“Eh,” Jack said. He couldn’t help but let the corners of his mouth pull into a smile. It might have been the first time all day that he was truly present. He finally heard the noises around him as they occurred, felt connected to his own hands as he helped Robby get the balloon in. All day, since 6:30 AM, he’d been in that trauma room, trying to pump a long-dead heart back to life. But now, he was here, in the PTMC where his body was.
“Balloon is up,” Robby said.
“Why don’t we stock these?” Dr. Mohan asked. Jack wondered the same thing.
Robby answered quickly, likely tired of having the same reason for any shortcomings in the ER. “No room in the budget.”
“Yellow on end-tidal,” Princess breathed, looking around at Jack and the other doctors with a mix of relief and wonder. Jack met Mohan’s sparkling eyes briefly, a grin on her face so wide you would have thought she was watching a puppy do a trick and wag its tail for a treat. That’s sort of what Jack felt like he embodied in that moment, anyway. His head buzzed. Adrenaline had been the thing keeping him going. Dull pulses of it, pulling his legs into a walk and sending signals to his hands to do the usuals. Crikes. IOs. Intubations. Sutures. Now, he knew he wanted more. He knew he was ready for a challenge.
You must ask yourself if it’s worth it.
“What else you got in your go bag?” Mohan asked, her smile turning up on one side as she hustled around him to move on to the next thing.
“Oh, just wait and see," Jack said, sparing a sideways glance at her as she skipped away. He’d never seen someone so happy to be at the scene of a tragedy. It was contagious.
-
8:32 PM
“I’m not gonna do anything,” Jack said, turning to Mohan. “You are.”
For the past hour and change he and Mohan had been engaging in some kind of parallel play, where occasionally he’d step in and answer a question for her. She’d never ask for him explicitly, but every time she’d raise a question he’d hear her voice through the hundred others around him and make sure to be the first one to assist her.
It was never a waste of time, teaching her something. He knew she’d hear every word and fire back any appropriate challenge to his assessment, and he’d learn something from it one way or another. He’d instruct her through the next procedure, even though he never really had to. She was receptive and engaged and he wanted to tell her how impressed he was but couldn’t find the right time to do it, or maybe couldn’t think of the right tone to say it in. She’d do a perfect assessment. He’d guide her through the possible diagnoses. She’d look at him for a minute, eyebrows tilted in, and he’d fight a smile, and then she’d think of what he was thinking, and he’d nod and throw some instructions in the air as she already got started on them because she’d anticipated exactly what he was going to say, and he’d walk away whispering under his breath that she was doing fantastic and Jesse would look at him funny and he’d keep his head down and get back to his patient.
They were in the thick of it, stuck with the worst of the worst injuries, the people he could feel slipping away. He’d hear Mohan in the back, nurses and junior residents and med students at her beck and call, and he’d lock back in on the medicine, and he’d remind himself why he was here, that it wasn’t his fault that these people showed up here today, that all he could offer them was what he spent a decade studying and two, three times as long practicing just to be at this point.
Now, he pulled Mohan away from the patient, ripping off his gloves and pulling open his phone.
“I was reading this study a few weeks ago. It was in this newsletter–”
“Korea Biomed!” Mohan said, pointing a blue nitrile finger at his screen. “I follow that one. I just read the one about electroporation therapy for liver cancer.”
Jack turned to her, shaking his head. “Sick, right?” Suppressing his giddiness at her following the same newsletter as him, he scrolled to the story about using a pigtail catheter to aspirate air caught in the patient’s heart. “Anyway, we have a hyperbaric chamber here but we don’t have the time to get him there, and this hospital didn’t have one available, period.” As she leaned in to look at his screen (which he noticed more now than ever had lots of cracks and fingerprint smudges, and he’d increased the font size, so it made him feel old), her loose strands of hair were nearly touching his face.
“Dilated right atrium and right ventricle…same as our patient,” Mohan noted. When she peeled off her gloves and reached for his phone, she let him take it, looking over her shoulder as she scrolled. “But, look, they had fluoro.” She looked up at him. “And when Walsh suggested getting him into the cath lab, you said–”
“It’s backed up. Everything’s backed up. If we want this guy to live, he’s not going anywhere. We have to do something here and we have to do it now.”
“So…oh, so that’s why you needed the pigtail.” She tore her eyes from the article and turned to him. “You could do an IJ, put in the pigtail with two holes for aspiration, do suction with a lockable syringe. 30 mL?”
Jack nodded. “Exactly what I had in mind.” He walked to the wall and grabbed two pairs of gloves, handing one of them to Mohan, who accepted them numbly.
“But…Dr. Abbot.” She looked back to the patient, then back to him. Jesse stood by, holding the patient in place after putting him in Trendlenberg. “Dr. Walsh seemed determined to get him to cath.”
“She did.” Jack walked over to the patient. “But she’s not here, and we’re both attendings, and you get to listen to whoever you think is right.” He nodded to Jesse. “Got that central line kit?”
“This isn’t my decision,” Mohan said. Jack grabbed the 18-gauge catheter and beckoned Mohan over. She moved, but the question was still all over her face.
“Yeah. Yeah, it is.”
“Are you serious about me doing this?” As scared as she sounded, he saw the quiet smile on her lips. He nodded slowly then looked to Jesse, who handed Mohan the 5 French pigtail. She rolled it in her fingers.
“Okay, then,” she said, straightening up and bringing her eyes back to the patient. “You got the IJ, then?”
“Yes, ma’am.” He paused. “No, actually, you got that, too.” She stared at him blankly as he placed the 18-gauge in her hands, swapping it out for the pigtail, and took the ultrasound transducer from Jesse. “C’mon, let’s go, Dr. Mohan. We don’t have a lot of time here. Mostly because if Walsh comes in here before this is in she’s gonna try and stop us.”
He talked her through the IJ, holding the transducer by the insertion. Just as Mohan finished up, Walsh burst into the room, hot-tempered and impatient per usual. The best doctors were usually the most annoying, one way or another. Jack and Walsh had a back and forth over the patient, all while he watched Mohan prep the procedure, inserting the guidewire, trying to cancel out two of her attendings fighting overhead without ending this poor man’s life.
She looked at Walsh. “Maybe I should–”
“Thread in the pigtail! Excellent idea, Dr. Mohan,” Jack said, raising the pigtail catheter. He knew how badly she wanted to do it, and he knew she could. She’d done a Burr hole with an IO–which was her idea–so she could do this. If his first impressions of her were anywhere near accurate, she was elated at the idea and doing her very best to hide it, but equally terrified of Walsh standing right in front of her, waiting to watch her fail. He looked into her eyes, trying to unlock that part of her he knew was there, that slight selfishness doctors had when they wanted to push themselves, when they desired to neglect the easy way out and gamble with their patient’s life for the sake of a life-changing boost in self-confidence as a medical professional.
Only thing was, ER doctors were special in that they had the privilege to do this often knowing there wasn’t any other way. Little time, little space, little resources, little information…He wanted to show Mohan that she was ready to take those risks.
He saw the surrender wash over her face, and she took the pigtail from him, briefly glancing at Walsh before inserting the catheter into the IJ. And it was just him and Mohan and the patient halfway to death between them, with Walsh bickering in the background, spewing discouragement out of pure bitterness. When Mohan looked up, nervous, Jack met her eyes and nodded again, trying to shoo away any uncertainty that she had so that she did this right and she’d never doubt herself again in a situation like this. Because while residents were to listen to their attendings and those with more experience, no one was always right, and from what Robby had told him about Mohan, she was the type to catch the few things that everyone else would miss. In the chaos of an ER, having a Slo-mo or two was essential.
She did it perfectly. Jack was bouncing off the walls in his head, satisfied with both Mohan and himself that he convinced her to do it and it was successful. Even with Walsh breathing down their necks, Jack having to physically step between her and Mohan when she tried to get in the way, Mohan didn’t seem fazed. Briefly hesitant, sure, but Jack made sure to ground her at every pause. Walsh was all about reminding her of the risks, of the fragile life on the bed in front of them, but Jack was trying to get her to think of the medicine, the feat of this procedure, and who it would make Mohan as a doctor were she to do it correctly. And his strategy won.
“Not too shabby, huh, Dr. Walsh?” Jack said once the patient was stable. They sparred for a minute about where to send him before Walsh stormed out. Jesse stepped away, cleaning up the area. Jack turned to Mohan.
“Solid work,” he said, hoping the pure childlike excitement on his face was hidden enough.
“That was your save, not mine.” Still too humble.
“Take the win, Dr. Mohan.”
He watched the smile stretch on her face finally as she looked down at the patient, appearing rather impressed with herself. “Thanks.”
But it was important to note that this was still an ass-backwards way of doing things, no matter how necessary it was.
“Besides, it was a little too risky for me to do myself,” Jack said.
“What?”
-
9:37 PM
As much as Jack hated to admit it, he’d been somewhat disappointed once the ER quieted down, because that was when the flatline tone came back. He helped out with a crushed pelvis, did a lot of charting, went to the bathroom, and all but floated around the ER for the last half hour, until he went to look for Robby and say goodbye.
When he’d asked Dana about his whereabouts on her way out and saw he was not in fact in the room with the mother of Jake’s dead girlfriend, he had a feeling where he would find him.
He managed to talk him down from the roof, which he was only able to do because after tonight he had a newfound understanding of this job that would maybe be the answer to him getting through the rest of his life if it held up.
Jack had found Mohan at the lockers on his way out, sniffling and wiping her tears with the back of her hand. He had time to kill, anyway, while Robby filled the night shift in on the remaining MCI patients.
She’d looked at him sideways, spared a pursed-lip smile, and nearly shoved her whole head into her locker as she gathered her things. He didn’t expect crying from her, but maybe he should have, her being described as “hyper-empathetic” by Robby.
“Tonight was a lot,” Jack said. “You couldn’t have handled it better.”
Mohan slowly backed out of the locker, reaching for her hoodie and shutting the door. She rested the back of her head against the lockers and shut her eyes.
“I felt good about it. Really good.” She crossed her arms. “Until about fifteen minutes ago, when I went to the bathroom and looked at myself in the mirror and realized I’ve never looked this tired in my life. And I just…” She took a deep breath, shaking her head.
“Yeah,” Jack said. “I usually like to run a bath, pour myself a glass of red wine, light a few candles, and just cry it out.”
Mohan laughed, short and weak. She flashed her eyes at him through wiry pieces of loose hair, a smile returning. He looked away, flustered, unsure of why he said that.
“I suppose I could try that. Maybe put on some Jeff Buckley.”
“No, the silence is the key. You gotta be alone with your thoughts.”
Mohan furrowed a brow at him. “Seriously?”
“Seriously.”
Mohan cocked her head to the side. “I’ve got really loud roommates that stay up super late, though, so that might not be an option.”
Robby was on his way from down the hall. Jack peeled himself off the lockers, hitching his bag up his shoulder.
“Well, if you tolerate this trauma factory long enough you can afford a quiet single for yourself and sob in silence all you want.”
She nodded, smiling feebly and dragging her thumb over the last few tears under her eyes. Robby didn’t look at either of them as he approached his locker and grabbed his stuff. Mohan stiffened before excusing herself. He meant to invite her to the park for a beer, but it felt weird to do that with Robby right there, doing everything to hold himself together. It felt wrong to speak at all in that moment.
But Mohan ended up there anyway, pulling her hair down and fluffing it around with her fingers. Jack steered his attention back to his leg, eye catching on his wedding band as he massaged his aching skin.