Chapter Six Emergency Department
Chapter Six
Emergency Department
The first thing Renji noticed about the man from the tunnels was the blood.
Not the amount — he had seen more. It was the pattern.
One deep penetrating wound below the ribs.
Another through the upper arm. A long laceration across the back.
Bruising along the jaw and temple. Dust ground into the skin of his hands and face.
These were not random injuries. Someone had tried to kill him. More than once.
"Transfer on three," Renji said. "One, two, three."
The trauma team moved Haruki Ishida from the ambulance trolley onto the bed.
The name had arrived ahead of him. So had the warnings — head of the Ishida Family, high-profile patient, security concerns, potential press interest. Renji discarded all of it the moment the man crossed the threshold.
In the emergency department, status was useful only when establishing next of kin.
Blood pressure did not improve for authority.
Haemorrhage did not pause for reputation.
"Pressure seventy-four over forty," Aoi called.
"Heart rate one thirty-eight."
"Two large-bore lines. Full trauma panel, cross-match six units. Activate massive transfusion."
"Already activated."
Akiko moved to the head of the bed.
"GCS ten. He was talking in the ambulance before he deteriorated."
"Airway?"
"Maintaining for now."
"Keep him on high-flow oxygen. We intubate if he drops any further."
Renji pressed gloved fingers to the wound beneath Haruki's ribs. Fresh blood welled around the packing. The injury angled upwards — possibly liver, possibly diaphragm, possibly both.
"FAST."
The ultrasound machine appeared beside him. Renji placed the probe against Haruki's abdomen. Free fluid. A great deal of it.
"Positive in the right upper quadrant," he said. "Pelvis clear."
Reina Kurogawa stood beyond the glass doors, held back by two nurses and a hospital security officer.
Blood covered the front of her coat — her own, or Haruki's, Renji could not tell.
She shouted something. The doors absorbed most of it.
Renji ignored her. Not out of cruelty. Because the man on the table required his full attention.
"Chest movement equal," Akiko said. "Saturations holding at ninety-four."
"Prepare CT."
Akiko looked at the blood pressure.
"He may not tolerate it."
"If the first units bring him up, we need the trajectory before theatre."
"And if they don't?"
"We go straight upstairs."
The first unit of blood was connected. Renji moved to Haruki's arm. The knife had passed through the upper biceps without striking the major vessels — painful, bloody, not immediately fatal. The abdominal wound was different. That one had been placed with intent.
His jacket had been cut open by the paramedics but still clung around one shoulder, stiff with blood and damp tunnel dust. Renji reached for the sleeve.
Haruki's hand moved. Weakly. His fingers closed around Renji's wrist.
The room paused for less than a second. Renji looked down. Haruki's eyes opened, dark and unfocused at first, then suddenly sharp — too sharp for a man with his blood pressure.
"Mr Ishida," Renji said.
Haruki's gaze dropped to the badge clipped at Renji's collar, then back up to his face. Recognition passed across it. Not of Renji himself. The name. Takahara. Renji saw it happen.
"What happened in the tunnels?" he asked.
Haruki's lips moved. No sound emerged. Akiko leaned closer.
"Don't try to speak."
Haruki ignored her. His grip remained around Renji's wrist.
"White…" he managed.
Renji waited.
"Lotus."
The words were barely audible. Something cold moved through Renji. It was gone before anyone could notice. He lowered Haruki's hand back to the bed.
"You can explain later."
Haruki's gaze remained fixed on him.
"The journal."
"Later."
"Your name."
Renji's expression did not change.
"Dr Takahara."
A faint smile broke through, exhausted but real.
Aoi looked at Akiko. Akiko looked at Renji. Renji continued cutting through the ruined shirt.
"What is?"
"I was hoping…" Haruki paused to breathe. "You were a hallucination."
"Hallucinations are not usually this expensive."
The monitor alarm changed pitch.
"Pressure eighty-two systolic," Aoi said.
"Second unit."
Renji turned back to the wound. Haruki still had hold of the edge of his sleeve — not enough strength to restrain him, enough to be noticed.
"Let go."
"You're very commanding."
"You are bleeding internally."
"I've had worse introductions."
Renji removed Haruki's hand.
"Take your jacket off."
Haruki blinked slowly.
"You usually ask people to undress this quickly?"
Aoi's mouth twitched. Akiko looked down to hide a smile. Renji did neither.
"You can remove it yourself, or I can cut through what remains of it."
"That wasn't a no."
Renji took the trauma shears. Haruki watched him do it with the solemnity of a man witnessing an execution.
"You're enjoying this."
"No."
"You didn't hesitate."
"I rarely hesitate while treating penetrating trauma."
"Cruel."
"Professionally efficient."
The jacket came free. Renji dropped it into the belongings bag. Beyond the glass, Reina made a sound of protest on Haruki's behalf. He turned his head weakly.
"Reina."
"She is safe," Renji said.
"Others?"
"We are treating everyone who arrived."
"Takeda?"
"I don't know their names yet."
"Minamoto. Jun."
Renji placed the ultrasound probe against his side again.
"Your responsibility at present is remaining alive."
"That's usually your responsibility."
"It is shared."
Haruki looked up at him.
"That sounds intimate."
Renji frowned.
"Does confusion feel worse?"
Akiko coughed. Aoi turned away. Haruki's smile deepened despite the pain tightening his face.
"No, Doctor."
"Any nausea?"
"Only when ignored."
Renji looked towards Akiko.
"Prepare analgesia."
"He's flirting with you," she said quietly.
Renji glanced back at Haruki. The man appeared pale, bloodied and near shock.
"He has significant blood loss."
"That doesn't answer what I said."
"It explains altered behaviour."
Haruki's eyes closed.
"I'm not altered."
"Good," Renji said. "Then you can answer questions properly."
One eye opened again.
"You wound me."
"That happened before you arrived."
Aoi laughed. It escaped before she could stop it. Renji looked at her.
"Sorry, Doctor."
"Continue recording."
"Yes, Doctor."
Haruki's gaze drifted towards Renji again.
There was amusement in it. That made no sense.
Most patients in his condition were frightened.
Some became angry. Some withdrew so deeply it became difficult to reach them.
Haruki Ishida flirted with his surgeon. Apparently.
Renji had not yet decided whether that represented courage or poor judgement. Likely both.
"Any allergies?" Renji asked.
"People who cut expensive clothing."
"Medication allergies."
"No."
"Current prescriptions?"
"None."
"Medical conditions?"
"None."
"Previous surgery?"
"Appendix. Fifteen."
"Complications?"
"Ugly scar."
"That is not a complication."
"It mattered when I was seventeen."
Renji palpated his abdomen. Haruki sucked in a breath.
"Pain there?"
"No. I make that sound when I'm enjoying myself."
Akiko's shoulders shook. Renji looked up. Haruki's face had gone tighter around the eyes. The humour was a shield. That, Renji understood.
"Your liver may be injured."
Haruki's expression steadied.
"How bad?"
"We do not know yet."
"Am I dying?"
The question arrived without fear. Renji met his gaze.
"Not if I can prevent it."
Something changed in Haruki's face. The smile remained.
The performance behind it did not. He studied Renji as though weighing the answer.
Most people with Haruki's position were accustomed to reassurance shaped around their importance — told everything possible would be done because of who they were.
Renji had offered no such promise. Only the truth.
For the first time since waking, Haruki looked disarmed.
Then the moment passed.
"Confident."
"Experienced."
"Arrogant."
"Also possible."
Haruki gave a weak laugh and immediately grimaced. The monitor showed another drop in pressure.
"Seventy systolic," Aoi said.
Renji's attention snapped back to the numbers.
"No CT. Theatre now."
Akiko nodded.
"I'll call."
"Tell them penetrating right upper quadrant, unstable despite two units. Possible hepatic and diaphragmatic injury."
Aoi moved with them as the bed unlocked. Reina pushed past the security officer when the doors opened.
"Haruki."
She reached the trolley before anyone stopped her. Renji stepped between them.
"We are taking him to surgery."
"Is he going to die?"
Haruki turned his head.
"Apparently not."
Renji looked down at him.
"I said not if I can prevent it."
"So serious," Haruki murmured.
Reina stared at Renji.
"Doctor?"
"He is critically injured. We believe there is ongoing internal bleeding. He needs immediate surgery."
"I'm coming."
"You cannot enter theatre."
"I'm not leaving him."
"You can wait upstairs."
"Do you know who he is?"
"Yes."
The answer halted her. Renji continued.
"His name is Haruki Ishida. He has lost a dangerous amount of blood and requires an operation. Nothing else about him changes what happens next."
Reina stared at him. Haruki did too. Then Haruki began to smile. Small. Almost invisible. But this time it was not flirtation. It was relief. Renji wondered how many people spoke to him without first speaking to the name.
"Reina," Haruki said.
She looked down.
"Go with Ken."
"Ken's still at the tunnel."
"Then find Mother."
"Haruki—"
"Please."
The word weakened her anger more effectively than any command. She took his hand.
"You come back."
"I'll try."
"No. Don't say that."
Haruki's expression softened.
"Then I'll come back."
Reina kissed his forehead. The trolley began moving. She walked beside it until the lift doors forced her to stop. Haruki watched her disappear. Only after the doors closed did he let his head fall back. The effort had cost him. His skin was almost colourless now.