Chapter 10
AREK
By two in the afternoon, I’d seen fourteen patients, counseled three parents, fielded two phone calls from the specialist in Seattle about the Henderson referral, and smiled so many times that my face had developed a muscle memory independent of my actual mood.
It had been the kind of day where the waiting room never fully emptied and the appointments stacked like dominoes, each one bumping into the next.
Mrs. Callahan had needed twenty minutes to talk through her husband’s new blood pressure medication, most of which was about her fear that he’d have a stroke like his brother.
I’d sat with her and listened because that was what she needed more than a prescription adjustment.
After her, there’d been a six-year-old with an ear infection who screamed through the otoscope examination while his mother apologized repeatedly.
I assured her it was fine, kids scream, it’s what they do, all while my eardrums contemplated early retirement.
Then Dave Stamoulis again, this time about his knee instead of his shoulder.
I was starting to suspect Dave just liked having someone to talk to, which I understood more than I wanted to admit.
Between patients, I restocked the supply cabinet, updated three charts, responded to an insurance query that required the diplomatic precision of a hostage negotiator, and microwaved a cup of coffee I’d forgotten about and then found an hour later, stone cold, on top of the filing cabinet.
I was fine. I was handling it. This was the job, and I was good at it, and being good at it was enough.
Fir found me in the breakroom around twelve-thirty, standing at the counter, eating a granola bar that constituted my lunch. He leaned against the doorframe with his tea and studied me with those steady eyes that missed nothing. “When’s the last time you ate an actual meal during a workday?”
“I’m eating right now.”
“A granola bar is not a meal, Arek.”
“It has protein. It says so on the wrapper.”
“So does dog food.”
I snorted, but Fir wasn’t smiling. He had that look, the one that was gentle and immovable at the same time, the doctor-examining-a-patient look. “You’ve been running hard. The flu season took a lot out of this practice, and you absorbed most of it.”
“We both did.”
“I went home on time three days this week. You stayed late four out of five.” He paused. “I’m not trying to manage you. I’m trying to tell you that I notice, and that you don’t have to carry the whole clinic on your shoulders.”
“I appreciate that, Fir. I’m fine.” The word sat between us with the hollowness it always had when I said it. “I’m off this afternoon. Two more patients and then I’ll head home.”
“Promise?”
I gave him a smile that I hoped was convincing. “Promise.”
Fir looked at me for another moment, then nodded and took his tea back to his office. I finished the granola bar and went back to work because that was what I did. I went back to work.
At one-fifteen, I was in Exam Room 2, reviewing a chart, when I heard the commotion.
It started with the front door banging open hard enough to hit the wall, followed by Janine’s voice at the reception desk rising in pitch and urgency.
I was on my feet and moving before the chart hit the counter because that kind of noise—sharp, disrupted, someone in distress—was a frequency my nervous system had been tuned to since my first rotation in the ER.
I came around the corner into the waiting room, and my heart stopped.
Mac was standing just inside the door, his left hand wrapped in towels that were soaked through with blood.
The blood had run down his forearm and was dripping steadily onto the floor.
His face was the color of concrete, his lips pressed into a line so tight they’d lost all color.
He was upright but listing slightly, his right hand braced against the doorframe, and his eyes were scanning the room with a rapid, unfocused sweep.
Those eyes found me. Locked on. And something in his face shifted, a fraction of tension releasing, like a man who’d been holding his breath and finally found the air.
I was moving toward him before I’d made a conscious decision, my brain already running triage.
Significant bleeding from the left hand, blood-soaked towels suggesting sustained hemorrhage, pallor and mild diaphoresis consistent with moderate blood loss.
He’d driven here, which meant he was conscious and oriented, but the slight sway in his stance told me his blood pressure was dropping and he didn’t have a lot of runway left.
“What happened?” I was beside him, my hands reaching for his injured one, already listing what I’d need—suture kit, irrigation, hemostats, possibly imaging if there was tendon or bone involvement.
“Saw kicked.” His voice was rough and strained. “Caught my palm. Couldn’t wait for an ambulance, and the hospital is too far.”
A table saw kickback injury to the palm.
Deep laceration, likely involving the thenar eminence and possibly the tendons of the thumb.
Profuse bleeding because hands were among the most vascular parts of the body, and a saw blade didn’t make clean cuts but tore, which meant more tissue damage, more bleeding, harder to close.
“Let’s get you into an exam room.” I had my hand on his arm, guiding him, already turning toward Exam Room 1 because it had the best light and the full suture setup.
My mind was three steps ahead. I’d have to irrigate, assess depth, check flexor tendon function, close in layers if the tissue was viable…
“Arek.”
Fir’s voice came from behind me. I turned. He was standing in the hallway with an expression I couldn’t immediately read, something between concern and a gentleness that stopped me mid-stride. “I’ve got this one,” he said.
“I’m already here, Fir. I can handle it.”
“I know you can.”
He stepped closer and dropped his voice low enough that only I could hear. His eyes held mine with that steady warmth that was his gift: authority without ego, honesty without cruelty. “He shouldn’t be your patient, Arek. And you shouldn’t be his doctor.”
The words landed like a stone dropping into still water, sending ripples outward through every carefully maintained fiction I’d built in my head. I opened my mouth to protest, then closed it again. He was right. Fir was absolutely, one hundred percent right.
My throat tightened. “I’ll stay with him,” I said. “Not as his doctor.”
Fir nodded. “Of course.”
He took over with seamless competence, guiding Mac into Exam Room 1 with a hand on his shoulder. I followed, and when I sat down on the stool next to the treatment table, my hands were shaking, and it wasn’t from the medical adrenaline.
Fir was careful with Mac, the deliberate, telegraphed approach of a doctor who knew his patient had PTSD.
He moved slowly, visibly, keeping his hands where Mac could track them.
No sudden reaches, no instruments appearing from behind or below Mac’s sight line.
Everything front-facing, everything narrated.
“I’m going to unwrap the towels now, Mac.
Then I’ll take a look at what we’re dealing with. ”
Mac sat rigid on the exam table, his jaw clenched so hard the muscle twitched.
His eyes tracked Fir’s hands with hyper-vigilant precision, registering every movement, every instrument that came into view.
He was letting himself be treated, but every line of his body said it cost him, that being in a clinical setting under someone else’s hands was an act of endurance.
Then he looked sideways at me. There was a question in his eyes, one he maybe didn’t even realize himself. I reached for him, putting my hand on his good lower arm. “I’m here.”
“Yeah,” Mac said, and that was enough. I left my hand where it was.
Fir unwrapped the towels. The laceration was an ugly, jagged gash across the palm, running from the base of the thumb diagonally toward the heel of the hand, deep enough that I could see the glistening white of tissue beneath the blood.
Not tendon, thank god, but close. The saw had left ragged edges that would need careful debridement before they could be closed.
“The good news is I don’t see tendon involvement,” Fir said. “The bad news is that this is going to need a thorough cleaning and a fair number of stitches. I’m going to numb the area first. You’ll feel a few sticks, then pressure, but no sharp pain. Okay?”
“Okay.” Mac’s voice was that of a man who’d endured much worse than a needle.
Fir administered the local anesthetic with practiced precision, warning Mac before each injection.
I watched from my stool and did the hardest thing I’d done in a long time, which was nothing.
I sat and watched someone I cared about be in pain, and I didn’t fix it.
I didn’t reach for gloves, didn’t offer to assist, didn’t do any of the things my hands and my training were screaming at me to do.
I just sat there, being present, being useless, my hand on Mac’s arm.
It was excruciating.
Fir irrigated the wound, debrided the ragged edges, then began suturing with great precision. Mac stared at the ceiling and breathed in controlled, deliberate patterns.
“Almost done,” Fir said with warmth and genuine care in his voice, and I was grateful for it. Grateful that Mac was in good hands. Grateful that those hands weren’t mine because mine would’ve trembled, and Mac needed steadiness.
After the last suture, Fir dressed the wound, wrapped the hand with clean gauze and a bandage, and gave Mac the rundown—keep it clean, keep it dry, refresh the bandage daily, no gripping or heavy use for at least ten days, and come back in a week for a check.
Mac listened with tight-jawed resignation.
No wonder. He was being told he couldn’t use a hand for ten days, when his hands were needed for the only things keeping him busy.