14. Callum
CALLUM
I was three stitches into closing a laceration on a kid's forearm when the doors banged open and someone shouted that there was a fire on Halstead.
The kid flinched. I steadied his arm and finished the row without looking up. The suture spacing had to be right or the scar would pull when he grew. I tied off, snipped the thread, and only then glanced toward the waiting room.
Ruth was already at the intake desk with the phone pressed to her ear. She looked up, met my eyes, and shook her head once. That meant it was bad.
I stripped off my gloves, told the kid to keep it dry, and walked out to the hallway.
Through the front windows I could see smoke rising a few blocks east, a dark column against the late afternoon sky that bent and thickened as I watched.
The sirens started a moment later, distant at first and then layered, coming from multiple directions.
"How many units?" I asked.
Ruth covered the receiver. "Four so far. Apartment building, six stories. They're still getting people out."
The first one came in ten minutes later, a woman in her sixties with burns on both hands and smoke inhalation that had her coughing hard enough to crack ribs.
Priya got her into an exam room and I followed, pulling on fresh gloves as I went.
The burns were second-degree, blistering across her palms and the inside of her fingers where she'd grabbed something hot.
I cleaned them, dressed them, checked her airway.
Her oxygen saturation was low but not critical. She'd live.
The second came in before I'd finished with the first. Then a third.
A kid, maybe eight, with a gash on his forehead from falling on the stairs during the evacuation.
His mother was with him, frantic, and I let her stay while I irrigated the wound and checked for debris.
Glass, probably from a broken window. I pulled two fragments, sutured the gash in four layers, and sent them both out to make room.
By the time I'd finished with the fifth case the waiting room was standing room only.
I looked through the doorway and saw maybe thirty people, some sitting on the floor, most of them coughing.
A man with a towel pressed to his face. A teenage girl holding her arm at an odd angle.
An older man slumped against the wall with ash in his hair and a vacant look that meant shock.
The intake desk had a line six deep and Ruth was working it alone, writing names on intake forms as fast as her hand could move.
Priya came out of the second exam room, saw the crowd, and swore under her breath. "Jesus Christ."
"Get triage going," I said. "Respiratory first, then heavy bleeding, then fractures."
She nodded and went. I turned back to the exam room and called the next name on the list Ruth had shoved at me.
The work blurred after that. A man with a broken wrist. A woman with second-degree burns on her shoulder and neck.
A kid who'd inhaled enough smoke that I had to bag him manually for three minutes before his sats came up.
I worked fast, the way I'd been trained to work, and I didn't stop to think about anything except what was in front of me.
Priya brought me a woman with a pneumothorax, her breathing rapid and shallow, her lips starting to blue.
I got a needle in and heard the hiss of air escaping the pleural space, felt the resistance give under my hand.
She gasped, coughed, and her color came back.
I put in a chest tube, secured it, and moved to the next case.
Somewhere in the middle of it Ruth appeared in the doorway with her phone in her hand and my coat over her arm. She didn't say anything, just held the phone out.
I didn't take it. "I'm busy."
"It's Bellhaven General Hospital. Dr. Ware."
I looked at her. Then I looked at the woman on the exam table in front of me, a laceration on her calf that needed cleaning and suturing, and at the line of people still visible through the door behind Ruth. I wiped my hands on a towel and took the phone.
"Desmond."
"Where the hell are you?" His voice was sharp. "Griffith's been here for an hour. The Merrick case is prepped and waiting and you're not in the building."
The Merrick case. I'd known it was coming—a valve replacement on a man with congenital defects so rare I'd only read about the anatomy in textbooks, never seen it.
The kind of case that appeared once in a career if you were lucky.
Griffith Hale had flown in from Boston to observe because he was writing a paper on exactly this pathology and there were maybe three surgeons in the world who could do it.
I was one of them.
"I can't make it," I said.
There was a pause. "You can't make it."
"No."
"Callum, this is the Merrick case. Griffith is here. The board's watching. Do you understand what I'm telling you?"
I understood. I looked at Ruth, at the woman on the table, at the people in the waiting room beyond. A kid sitting on the floor with his head between his knees. An elderly man coughing into a blood-stained cloth.
"I can't leave," I said.
"If you don't show up for this, Morrison's going to take it.
You know that. And if Morrison takes the Merrick case, the board's going to ask why you weren't there, and when they find out you just didn't come in, they're going to ask what the hell you think you're doing.
This isn't a conference you can skip. This is the case of the year and your name is on the door. "
"Then Morrison should take it," I said.
Another pause, longer this time. "What?"
"I said Morrison should take it. He's a good surgeon. He'll do fine."
"Callum—"
"I have to go, Desmond."
I handed the phone back to Ruth and turned to the woman on the exam table. Her eyes were wide. She'd heard the whole thing.
"Is everything okay?" she asked.
"Everything's fine," I said, and reached for the irrigation syringe.
Ruth stood in the doorway for another moment, then left without a word. I heard her voice in the hallway a minute later, calm and steady, calling the next name.
The cases kept coming. I lost count somewhere around fifteen.
A man with a dislocated shoulder that I reduced in four seconds flat, the joint popping back into place with a sound he felt more than heard.
A woman with burns bad enough that I knew she'd need a graft, but I cleaned and dressed them and gave her enough morphine to get her through the night.
A teenager with a broken nose and two cracked ribs from being trampled in the stairwell.
The light outside faded and the overhead fluorescents buzzed and flickered. Someone brought me a cup of coffee that went cold on the counter. My hands started to ache. I ignored it.
Priya came in with a man who wasn't breathing right, his chest moving but no air getting through.
I looked, saw the swelling in his throat, knew what it was.
Anaphylaxis, probably smoke exposure triggering an underlying allergy.
I got the airway in, watched his chest start to rise and fall properly, and taped it in place.
His eyes followed me the whole time, terrified.
I told him he was going to be fine and I meant it.
Around eight o'clock we ran out of gauze.
Ruth sent someone to the pharmacy down the street but they were closed and we made do with what we had, cutting strips smaller, using them twice when we could get away with it.
The supply cabinet in the hallway stood open and half-empty.
I needed sutures and there were three packs left. I took one and made it last.
A woman came in with her daughter, maybe sixteen, who'd fallen three floors when a fire escape collapsed.
Compound fracture of the left femur, bone visible through the skin, bleeding controlled but not stopped.
I got her on the table, started an IV, pushed morphine.
The girl was crying. Her mother wouldn't let go of her hand.
I reduced the fracture manually, felt the bone ends grind and then align, and splinted it with what we had—two wooden rulers and an ace bandage someone found in a drawer.
It wasn't enough. She needed surgery, a hospital, an OR.
But it would hold until an ambulance could take her and right now there were no ambulances available.
I told her mother to keep pressure on the wound and call me if the bleeding got worse.
The girl looked at me. "Am I going to lose my leg?"
"No," I said.
She believed me. I didn't know if I believed myself.
Two more cases came in after that, both with smoke inhalation bad enough that I had to nebulize them in the hallway because the exam rooms were full.
I stood there with the nebulizer in one hand and my other hand on an elderly man's wrist, counting his pulse, watching his oxygen saturation creep back up on the monitor Priya had wheeled out from somewhere.
The man's wife stood beside him, holding his coat.
She didn't say anything. She just watched.
By ten o'clock my back hurt from bending over exam tables.
My fingers were stiff. I'd gone through four pairs of gloves in the last hour and the trash can in the corner was overflowing with used supplies, blood-stained gauze, empty medication vials.
The air smelled like smoke and antiseptic and something else I couldn't name, something that always showed up in rooms like this when there were too many people and not enough time.
A man came in holding his hand wrapped in a towel, blood seeping through. I unwrapped it and found a laceration across his palm, deep enough that I could see the tendon. He'd cut it on broken glass trying to get back into his apartment for his dog. I asked if he'd found the dog. He said no.
I numbed the hand, irrigated the wound, and sutured it in two layers. The tendon was intact but close. Another quarter inch and he wouldn't have been able to move his fingers. I told him that. He didn't seem to care.
"The dog's name was Scout," he said.
I tied off the last suture and dressed the wound. "I'm sorry."
He nodded and left. Priya brought in the next case before I'd finished cleaning up.
It was past eleven when a kid came in seizing.
His father carried him through the door and Priya got him onto a table.
I checked his airway, turned him on his side, watched the seizure run its course.
It lasted forty seconds. When it stopped the kid was unresponsive, his pupils slow to react.
I got an IV in, pushed lorazepam, and waited.
His eyes opened. He looked at me and started crying.
"You're okay," I said. "You're fine."
His father was standing in the corner with his hands over his face.
I asked him if the kid had a seizure disorder.
He said no. I asked if he'd hit his head.
The father didn't know. Probably smoke exposure, maybe hypoxia during the fire.
The kid's oxygen saturation was ninety-four percent now, better than it had been.
I told the father to take him to Bellhaven General Hospital tonight, not tomorrow, and to tell them about the seizure.
"Can't you just keep him here?" the father asked.
"No," I said. "He needs a CT scan and we don't have one."
The father looked around the room, at the empty supply cabinet, at the overflowing trash, at Priya standing in the doorway with another intake form in her hand. He nodded. "Okay."
They left. Priya came in with the next name.
A woman with a burned hand. A man with a gash on his arm. A teenager with a sprained ankle. The cases were getting smaller now, less critical. The worst of it was over. I kept working.
It was past midnight when Ruth found me again. I was suturing a gash on a woman's leg, the kind of clean laceration that probably came from sheet metal or broken glass. The waiting room had finally emptied. The hallway was quiet.
Ruth was standing in the doorway with my coat still over her arm. She looked exhausted. There was blood on her shoes and her hair had come loose from the bun.
"Desmond called back two hours ago," she said. "Morrison took the case. It went well. Griffith was impressed."
I kept my eyes on the suture. The spacing had to be even.
"The board met after the case finished," Ruth continued. Her voice was carefully neutral. "Desmond said they're giving Morrison your post. Head of the surgical department. Effective immediately."
I tied off the suture and reached for the scissors.
"When you write up tonight," I said, "don't put my name on anything."
She blinked. "What?"
"No name. You needed an extra pair of hands and somebody helped. That's all."
"Callum—"
"That's all," I said again.
She looked at me for a moment, then nodded slowly. "All right."
I snipped the thread, checked the tension, and nodded to the woman. She thanked me. I told her to keep it clean and see her regular doctor in a week.
When she left, Ruth was still standing in the doorway.
"That's the last one," she said.
I stripped off my gloves and dropped them in the trash. I washed my hands at the sink and dried them.
I took my coat from Ruth's arm, pulled it on, and checked the pockets. The ring was still there, a small weight I'd gotten used to. I left it where it was.
The hallway was empty. The exam rooms were dark. Through the front windows I could see the street outside, wet from the fire hoses, the smoke gone now. A few people still stood in clusters under the streetlights, talking quietly, but the sirens had stopped.
I walked to the door, pushed it open, and stepped out into the cold November air. Behind me I heard Ruth lock the clinic door. I didn't look back.
The Reid house was dark when I got home. I let myself in, hung my coat in the closet, and stood in the kitchen for a minute listening to the silence. Then I went upstairs, showered, and got into bed.
The ring stayed in my coat pocket. I didn't take it out.