Chapter 16 Triage
Triage
PRESTON
The difference between a Boardroom and a Trauma Bay is the noise.
Upstairs, silence is a currency. Down here, silence means someone is dead.
Max and I hit the double doors of the ER at a sprint. The scene inside is pure, unadulterated havoc. It is a canvas painted in red and adrenaline. Stretchers are lined up three deep in the hallway. Nurses are shouting vitals. The floor is slick with things I don't want to think about.
And the smell. Copper, diesel fuel, and fear.
I take a deep breath. It smells like home.
“Jax!” Max barks, his voice cutting through the din like a knife. “Sitrep!”
Jax is standing on a chair in the centre of the nursing station, directing traffic like a conductor of chaos. He sees us. He sees Max in his white coat and me in my ruined dress shirt.
He grins. It is a feral, terrifying expression.
“Mass casualty!” Jax yells over the scream of a patient. “Bus versus semi-truck. We have twenty-two critical, twelve walking wounded, and they’re still pulling people out of the river. We are drowning in blunt force trauma!”
He points at Max.
“Max, Bay 1. Tension pneumothorax. Crack the chest!”
“On it,” Max says, shedding his white coat as he runs.
Jax points at me. He doesn't look surprised I’m here. He looks like he expected it.
“Suit!” Jax yells. “Bay 3 and 4 are overflowing. Silva is drowning in Bay 3. Get in there and make yourself useful!”
My heart stutters. Luke.
“Moving!” I yell.
I run toward Bay 3. I grab a pair of gloves from a wall dispenser, snapping them on as I slide into the room.
It is a bloodbath.
There are two patients in the room—a teenage girl with a compound fracture on the gurney, and a man in a bus driver’s uniform on the trauma table, who looks grey and lifeless.
Luke is bouncing between them. He’s trying to reduce the girl’s fracture while shouting orders for the driver. He looks wild-eyed, sweaty, and overwhelmed.
“I need a reduction team on the leg!” Luke screams. “And somebody hang O-Neg for the driver! Where is my resident or an intern? Where is Jenkins?”
“Jenkins is hyperventilating in the hallway!” I announce, stepping up to the teenage girl. “I’ve got the reduction. You take the driver.”
Luke’s head snaps up.
He sees me. He sees the charcoal suit trousers. He sees the rolled-up sleeves. He sees the gold cufflinks I haven't had time to take off.
For a second, the shock freezes him.
“Preston?” he breathes. “You… you’re supposed to be upstairs. You’re supposed to be signing papers.”
“The pen ran out of ink,” I lie, grabbing the girl’s ankle. “And the view was boring. Traction on three?”
“Get out,” Luke snaps, his shock turning instantly to anger. “I don't need tourists down here, York. Go back to your sparkling water.”
“I’m not a tourist!” I snap back. “And this leg is losing circulation. Are you going to argue with me, or are we going to set this bone?”
Luke glares at me. The girl whimpers.
“Fine,” Luke hisses. “On three. One. Two. Three.”
We pull. CRACK. The bone slides back into place. The girl screams and then sags with relief as the sedation hits.
“Pulse is back in the foot,” I confirm, checking the dorsalis pedis. “Splint it, nurse!”
I turn to the main event: The bus driver.
Luke is already there, frantically cutting off the man’s shirt.
“He’s hypotensive,” Luke barks, refusing to look at me. “BP 70 over 40. Rigid abdomen. Likely retroperitoneal bleed.”
“I’m tagging in,” I say, moving to the other side of the table.
“I didn't ask for help!” Luke yells, grabbing the ultrasound probe.
“You didn't have to!” I yell back, grabbing the suction. “That’s how a team works, Luke! We help each other!”
“We aren't a team!” Luke slams the probe onto the patient’s stomach. “You quit! Remember? You took the golden parachute because it was ‘easy’!”
“I didn't take it!” I shout, suctioning blood from an open laceration on the man’s chest. “I resigned! I left the papers on the table!”
Luke pauses for a microsecond. “You… what?”
“Positive FAST scan!” I interrupt, pointing at the monitor. “Free fluid in the belly. He’s bleeding out. We need to open him up. Now.”
“We can’t move him to the OR,” Luke says, his voice tight. “He’ll code in the elevator.”
“Then we do it here,” I say. “Crash laparotomy. Scalpel.”
Luke looks at me. “You’re wearing a three-thousand-dollar suit.”
“And you’re wasting time!” I grab the betadine bottle and splash it over the patient’s stomach, ruining my pants instantly. “Cut him, Silva!”
Luke grabs the scalpel. He makes the incision.
For the next ten minutes, we are fighting a war on two fronts: against the patient’s dying anatomy, and against each other.
“Retractor!” Luke orders.
“Retracting!” I pull back the muscle wall. “You know, for a guy who preaches about listening, you’re really bad at hearing me!”
“I heard you!” Luke snaps, diving his hands into the abdominal cavity. “You said you belonged in the boardroom! You said you were ‘winning’!”
“I was lying!” I shout. “Suctioning the spleen! I was hurt because you called me a fraud!”
“I called you a fraud because you were leaving!” Luke finds the bleeder. “Damn it, it’s the splenic artery. I can’t get a grip on it. It’s too slick.”
“Let me try,” I say.
“No, I got it!”
“Luke, move your ego!” I jam my hand into the incision, sliding my fingers past his. Our hands collide inside the patient. It’s warm, slick, and intimate in the most gruesome way possible.
“I have the vessel,” I grunt, pinching the artery. “Clamp.”
The monitor stops its frantic alarm and settles into a steady rhythm.
Luke exhales. He looks at me over his mask. His eyes are wide.
“You… you stopped the bleed.”
“I told you,” I say, sweat dripping down my forehead. “I have good hands.”
“You’re an idiot,” Luke breathes. “You resigned from the Board? Seriously?”
“I told Alistair to go to hell,” I confirm. “And then I ran down countless flights of stairs because I missed the noise. And I missed the blood.”
I look him dead in the eye.
“And I missed you, you stubborn ass.”
Luke stares at me. The anger in his eyes dissolves, replaced by that raw, terrifying vulnerability I saw in his apartment.
“You came back,” he whispers.
“I’m not a tourist, Luke,” I say, my voice steady. “Tourists visit. I live here. In the mud. With you.”
“It’s blood,” Luke corrects automatically, his voice cracking.
“It’s a metaphor, Dr. Silva. Accept the romance.”
Luke lets out a wet laugh. He grabs a needle driver.
“Tie it off,” he orders softly. “And don't mess up my suture line.”
“I learned from the best,” I say, taking the needle.
We fall into a rhythm. The fighting stops. The sync returns. I tie; he cuts. He sponges; I retract. We move around the patient like water, seamless and fluid.
“Nice knot,” Luke murmurs as I finish the ligation.
“Thanks,” I say. I lean closer to check the field, my shoulder pressing firmly against his. “I’m thinking of framing this suit. Putting it in a shadow box. ‘The day I got real.’”
“It’s ruined,” Luke says, glancing at the devastation of my charcoal wool.
“It’s improved,” I correct. “It has character now.”
Luke looks at me. The patient is stable. The bleeding has stopped. We are standing chest-to-chest, covered in gore, breathing hard.
“If we get out of this shift,” Luke says, his voice low and smoky, “I’m taking you back to Queens.”
“For pizza?”
“No,” Luke says, his eyes dropping to my lips (or where they would be under the mask). “To finish the conversation we started in the hallway. And to take those cufflinks off.”
“I’m keeping the cufflinks,” I tease. “I like the contrast.”
“Preston,” Luke warns, but he’s smiling.
“Luke,” I reply, leaning in until our foreheads bump.
The air between us is crackling. The nurse is staring at us. The teenage girl with the broken leg is staring at us. I don't care.
“I love you,” I whisper.
Luke freezes. “You picked a hell of a time to—”
“HEY!”
A roar from the doorway shatters the moment.
We both jump apart.
Jax O’Connell is standing there. He is covered in soot. He is holding a clipboard like a weapon.
“Are you two flirting?” Jax bellows. “Are you actually eye-banging each other over an open abdomen?”
“We are operating!” I defend, though my ears are burning.
“He’s stable!” Luke adds quickly, checking the monitor.
“I don't care!” Jax yells. “There are ten more patients in the hallway! Finish the close, wash your hands, and GET A ROOM! Or so help me god, I will hose you both down with the decontamination sprayer myself!”
He points a finger at me.
“And you! Suit! You look like a hitman who had a bad day. Fix the fascia and get to Bay 5! Jenkins fainted again!”
Jax spins around and marches back into the war zone.
Luke and I look at each other.
Under the mask, Luke’s eyes crinkle. He starts to laugh. It’s a joyous, relieved sound.
“We’re in trouble,” Luke says.
“We’re in so much trouble,” I agree.
“Bay 5?”
“Bay 5.”
“Hey, Preston?”
“Yeah?”
“Welcome home.”
I smile, snapping a fresh clamp.
“It’s good to be back, Doctor.”