Chapter 5
The "Emergency" Visit
LUKE
The Emergency Room at St. Jude’s usually smells of three things: antiseptic, stale coffee, and varying degrees of panic.
I am currently at the triage desk, trying to explain to a college student why swallowing a glow stick was a bad idea, even if it was for "the aesthetic."
“It’s not glowing inside me, is it?” the kid asks, looking down at his stomach.
“No,” I say, rubbing my temples. “But the chemicals are toxic. Don’t vomit on the floor. Aim for the bucket.”
The automatic doors slide open.
Usually, the doors open for paramedics, frantic relatives, or the walking wounded. Today, they open for a woman who looks like she just stepped out of a Vogue editorial titled "How to Dress for a Hostile Takeover."
She is wearing a pale beige-coloured power suit that costs more than my medical school debt. She has oversized sunglasses on, indoors. And she is clutching a Louis Vuitton carrier against her chest like it contains the Crown Jewels.
She stops at the entrance. She looks at the waiting room—at the crying babies, the guy holding an ice pack to his head, the vending machine.
She shudders. Visibly.
She walks up to the triage nurse, Jenkins (who is currently eating a bagel).
“Excuse me,” the woman says. Her voice isn’t loud, but it carries a frequency that shatters glass. “Where is the concierge line?”
Jenkins blinks, bagel halfway to his mouth. “The what?”
“The concierge. The priority queue. For donors.” She taps a manicured fingernail on the desk. “I do not have time to wait behind people who are… leaking.”
I sigh. I cap my pen. “Stay here,” I tell the glow stick kid.
I step out from behind the desk. As Chief Resident, handling the high-maintenance walk-ins unfortunately falls under my jurisdiction.
“Ma’am,” I say, using my best calm-down voice. “I’m Dr. Silva, the Chief Resident. There is no concierge line. This is an Emergency Room. We triage based on medical urgency, not donation status.”
She turns to me. She lowers her sunglasses. Her eyes are ice blue and terrifyingly sharp.
“Dr. Silva,” she reads my name tag as if it is a typo. “You look… tired. Are you competent?”
I stiffen. “I am very competent. Do you have a medical emergency?”
“I do,” she says. “It is critical.”
She unzips the Louis Vuitton bag.
A small, trembling Yorkshire Terrier with a diamond-encrusted collar pokes its head out. The dog looks perfectly healthy, if slightly embarrassed.
“This is Duchess,” the woman announces. “She is listless. She refused her organic salmon mousse this morning. I suspect a neurological event.”
I stare at the dog. The dog stares at me. It licks its nose.
“Ma’am,” I say, my voice straining. “This is a hospital for humans. Homo sapiens. We do not treat dogs. There is a veterinary clinic three blocks down on—”
“The vet is pedestrian,” she snaps. “It smells like wet fur and failure. This is a St. Jude’s medical emergency. My husband is Alistair York. I suggest you find someone who knows how to treat a delicate constitution before I have this entire wing turned into a parking garage.”
My brain stutters. York.
Suddenly, the vintage Porsche in the garage makes sense. The espresso machine makes sense. The bespoke scrubs make sense. This isn't just a rich lady; this is the Mothership.
“Mrs. York,” I say, trying to hold my ground. “I respect your husband’s contributions. But I cannot admit a canine. It is a health code violation. I have a sterile field to maintain.”
“I will buy you a new sterile field,” she counters instantly. “I will buy the MRI machine. I will buy the building. Just look at her!”
She thrusts the dog toward me.
“She sighed, Dr. Silva! She sighed heavily.”
“Dogs sigh, Ma’am. It’s a respiratory function.”
“Not like this. This was an existential sigh.” She looks around the ER with disdain. “Is there a private room? The lighting out here is aggressive. It’s making her anxious.”
“It’s making me anxious,” I snap, losing my patience. “Ma’am, please remove the animal or I will have to call security.”
“Security?” She laughs. It is a cold, tinkling sound. “I pay their salaries. Try again.”
I am about to call security anyway when I hear a familiar, tired drawl from behind me.
“Mother.”
We both turn.
Preston York is standing near the nurses' station. He is holding a stack of charts. He looks like he wants the floor to open up and swallow him whole.
“Preston!” Catherine York beams. “Thank goodness. Someone with a brain. Duchess is dying.”
“Duchess is not dying,” Preston says, walking over.
He doesn't look at me. He keeps his eyes fixed on his mother, his posture shifting. The slouch he usually adopts to annoy me vanishes, replaced by a rigid, perfect posture. He looks… dutiful.
“She’s likely just constipated because you fed her the Brie again,” Preston says.
“I did no such thing! She is depressed. Look at her eyes, Preston. They lack luster.”
“Mother,” Preston says, stepping smoothly between me and her, effectively shielding me from the blast radius. “Dr. Silva is right. We can’t treat her here.”
“Why not? I brought my chequebook.”
“It’s not about money,” Preston says, lowering his voice to a conspiratorial whisper. “It’s about… the magnet.”
Catherine frowns. “The magnet?”
Preston nods solemnly. “The MRI machine here? It’s calibrated for human density. 1.5 Tesla. If we put Duchess in there? The magnetic resonance could scramble her equilibrium.”
Catherine gasps, clutching the bag tighter.
“She’d never walk in a straight line again,” Preston continues, improvising wildly. “She’d be dizzy at the National Dog Show. She’d fall off the podium. Imagine the press, Mother. ‘York Dog Stumbles.’ It would be a PR nightmare.”
Catherine looks horrified. “Is that true?”
“Absolutely,” Preston lies. He turns to me. “Dr. Silva, back me up. The Tesla calibration is strictly for bipedal hominids, correct?”
I blink. I look at Preston. He is giving me a look of desperate, pleading panic.
“Uh,” I say. “Yes. Strictly bipedal. The… polarity… would be catastrophic for a Yorkshire Terrier.”
Catherine steps back, looking at the MRI sign like it is a death ray.
“Well,” she says, shaking. “Why didn’t you say so immediately? We must get her to a safe environment.”
“Exactly,” Preston says. “But we need to stabilize her first.”
He reaches into his pocket and pulls out a pair of exam gloves. He snaps them on.
“Mother, put her on the counter. I need to do a field assessment.”
Catherine places the dog on the triage desk.
Preston steps up. He puts his stethoscope in his ears. He places the diaphragm on the dog’s chest. He listens intently. He frowns. He checks the dog’s gums. He lifts one paw and checks the reflex.
He looks like he is defusing a bomb.
“Mmm,” Preston hums. “Tachycardia. Elevated cortisol.”
“Oh god,” Catherine whispers.
“It’s the environment,” Preston diagnoses, pulling the stethoscope off. “She’s sensing the ambient stress of the waiting room. It’s affecting her chi.”
“I knew it!” Catherine cries. “I told you, Dr. Silva! The energy in here is toxic!”
“It’s very toxic,” Preston agrees. “Here is my professional medical opinion. You need to evacuate immediately.”
“Evacuate to where?”
“The Penthouse,” Preston orders. “Turn the AC to sixty-eight degrees. Close the blackout curtains. She needs a low-stimulus environment. And for diet?”
He pauses, looking thoughtful.
“Filtered water. And… sliced cucumber. No salmon.”
“Cucumber,” Catherine repeats, nodding solemnly as if receiving a cure for the plague. “For the antioxidants.”
“Precisely. It will flush the toxins causing the melancholy.” Preston leans back. “Now go. Quickly. Before she inhales any more… public air. And don’t bother Max, he’s in a very complex surgery involving… fluids.”
Catherine zips the bag with decisive speed. She adjusts her sunglasses.
“You always were the sensible one, Preston. Though I still don’t understand why you insist on playing doctor in this…
petting zoo.” She casts a withering look at the glow stick kid, who is now dry-heaving into a bucket.
“Call me later. Your father is threatening to buy a vineyard in Napa and I need you to talk him out of it. He doesn't even drink Merlot.”
She turns and marches out, the click-clack fading into the distance.
Silence returns to the triage station.
I stand frozen, staring at the empty space where the hurricane just was.
Preston lets out a long, ragged breath. He rips off the gloves and tosses them in the bin. He sags against the counter, rubbing his face with both hands.
“I’m sorry,” he mumbles into his palms. “I’ll… I’ll go clean the bedpans in Trauma 2 as penance. I’ll scrub the floors. I’ll wax the floors.”
I stare at him.
I have spent the last week thinking Preston York is a useless, spoiled tourist. I thought he was here to play dress-up.
But I just watched him diagnose a dog with "toxic chi" to save my ER from a hostile takeover.
“You just…” I struggle for words. “You told her the MRI would scramble the dog’s equilibrium.”
Preston looks up. He looks exhausted. “You can’t fight crazy with facts, Luke. You have to fight it with bigger, more expensive crazy. If you tell her ‘no,’ she buys the building. If you tell her the building isn’t good enough for her dog, she leaves.”
“And the cucumber?”
“She hates the smell of salmon,” Preston shrugs. “If the dog eats salmon, the dog smells like salmon. If the dog smells like salmon, Mother gets a migraine. If Mother gets a migraine, she calls me.”
He picks up his charts.
“It was a preventative measure. For my own sanity.”
I watch him.
“York,” I say.
He flinches, expecting a reprimand. “Yeah?”
I look at the exit, then back at him. The corner of my mouth twitches up.
“Melancholy?”
“She’s a sensitive Aquarius,” Preston deadpans.
Before I can respond, the elevator doors ping open behind us.
Dr. Maxwell York, our Chief of Cardiothoracic Surgery—and Preston’s older brother—strides out, looking fresh and imposing in his black scrubs. Dr. Jackson O’Connell, the Chief of Trauma, is right beside him, eating a mandarin orange.
“Why does it smell like Chanel No. 5 and guilt down here?” Max asks, sniffing the air. He freezes, his eyes darting around the ER with genuine panic. “Tell me I imagined it.”
Preston sighs, leaning against the nurses' station. “You missed her by thirty seconds, Max.”
Max visibly sags, leaning against Jax for support. “Oh, thank God.”
Jax pops a slice of orange into his mouth, grinning. “Was it Duchess? Please tell me it was Duchess.”
“It was Duchess,” Preston confirms. “She had melancholy. I prescribed cucumber and sent them to the penthouse.”
Jax barks out a laugh. “Classic. Good save, kid. Did she try to buy the MRI?”
“She threatened to turn the wing into a parking garage,” I supply.
Max winces. “She would do it, too. She hates finding parking in the city.”
Max walks over to Preston. He puts a hand on his brother’s shoulder. It’s a rare moment of genuine affection.
“You took the bullet,” Max says. “Good. That’s what interns are for. I owe you a scotch.”
“You owe me a bottle,” Preston corrects.
“Done. I’m going back upstairs before the scent lingers on my scrubs.”
Max turns and flees. Jax winks at us and follows.
The elevator doors close, leaving us alone again.
Preston looks at me. There is a faint flush on his cheeks.
“So,” he says awkwardly. “About those bedpans?”
I shake my head. I point my pen at the waiting room.
“Forget the bedpans,” I say. “Go help the glow stick kid. Use your… specific talents.”
Preston blinks. “My talents?”
“Yeah. Tell him if he throws up the glow stick, he loses his aura or something. Lie to him, York. Make him behave.”
Preston smiles. It’s small, genuine, and tired.
“On it, Chief.”
He walks away.
I watch him go. And for the first time since he drove his Porsche into my parking garage, I don't want to fire him.
I just want to see what he does next.