3. Lance
Lance
Two months later
The thing about working in an emergency department is that you don’t get to choose when disaster decides to strike.
You can’t pencil in traumas between two and four on a Wednesday or politely ask cardiac arrests to hold off until after lunch.
The ED runs on its own clock, driven by constant rush of adrenaline, bad coffee, and people hitting their limits the hard way. That’s exactly why I like it.
Most people would find it nauseating. I find it weirdly comforting, the vibe of a place where things actually get done.
The main floor sprawls out in front of me.
Twelve bays sit in a horseshoe around the central nurses’ station, each sectioned off by royal blue curtains that give the illusion of privacy while letting everything carry from one bay to the next.
Monitors beep in competing rhythms, a constant noise that would wear most people down but that I read without thinking.
Heart rates, oxygen saturation, blood pressure, all feeding live data without a pause.
I head straight for the locker room, strip out of my jeans and t-shirt, pull on the navy-blue scrubs that mark me as nursing staff.
I clip my ID and tie my gray Nikes tight.
I grab my stethoscope from my locker and catch a glimpse of myself in the mirror on the inside of the door.
Sandy blond hair, messy and stubborn. Clean-shaven, pale skin, the faint dusting of freckles across my nose that no amount of sun manages to darken into anything more useful.
My blue-gray eyes look tired despite six hours of sleep last night, which counts as a luxury by nursing standards.
I’ve built some real muscle over the past few years, finally started eating like an adult, started dragging myself to the gym with some consistency.
It’s not enough to turn heads, but the shoulders actually fill out the scrub top now.
Small mercies. At five eleven with a straight-backed, ready-for-shift posture, I pass for more put-together than I feel.
“Lance, you’re early.” Nate’s voice carries across the ED floor before I’ve made it to the nurses’ station.
He’s in his usual spot, the charge nurse’s throne that gives him a clear view of all bays plus the trauma rooms in the back.
Graying temples, dry humor, the particular economy of movement that comes from twenty-five years of watching every possible way a human body can fail.
“Saw we had a full house at shift change,” I say, logging into the workstation and pulling up the patient assignment board. “Figured you could use the hands before the evening rush.”
Nate watches me start redistributing the assignment spread before he’s even begun the handoff.
“Told the nursing director last week you might be ready for charge,” he says, matter-of-fact, already pulling up the first chart. “She agreed. We’re working out the timeline. I’m thinking about retiring next spring and sleeping in for once in twenty-five years. My wife would appreciate it.”
I actually stop what I’m doing and look at him. “You can’t retire. That’s not allowed.”
Nate was on my interview panel six years ago. He’s the reason I know how to run a trauma bay without losing my head, or tell a family their person isn’t coming home without losing myself in the process.
He snorts and gives me the look he gives residents who ask obvious questions. “You’ll figure it out.” He pulls up the next chart. “You know this floor better than half the people who’ve been here twice as long.”
He says it blunt and offhand, like he always does. “We’ll see how the process goes. There’ll be other applicants, but you’re the top pick. You’ve put in the years and the work. It shows.”
He leaves it at that, but I’m not sure what to say. I just nod and turn back to the board.
“Anyway, we’ve got a mixed bag today. Bay 4 is chest pain, probably indigestion or reflux, but we’re running the full cardiac workup because he’s got risk factors.
Bay 7 is a nine-year-old with a fever. Mom’s worried it’s meningitis, but hopefully it’s just another common virus.
Bay 9’s a hand laceration from a beer bottle incident. ”
“A beer bottle incident…I’d tell you it happened with me in college, but it could’ve been last week too.”
“Knowing you, probably closer to last week.” Nate hands me a stack of charts. “You’re taking Bays 2, 5, and 8 to start. Josh is floating as tech, so grab him if you need an extra set of hands.”
“Josh, Mr. Always-On-It? I can’t wait to work with that enthusiasm in action.”
“That’s the one. Consider it character building.”
I take the charts and head toward Bay 2, where an elderly woman is waiting for lab results on what’s probably a urinary tract infection.
The curtain is pulled back just enough to see her sitting on the gurney, hands folded in her lap with the patience of someone who must have been through this before.
“Mrs. Hiddleston?” I knock on the frame even though the curtain is already open, because barging into someone’s space without warning is a great way to get punched by a confused patient. “I’m Lance, and I’ll be your nurse for the afternoon. How are you feeling?”
“Same as I told the last nurse,” she says, but she’s smiling when she says it. “It’s burning when I pee and I feel tired all the time. My daughter insisted I come in.”
“Smart daughter.” I wash my hands at the sink mounted on the wall, the hot water and industrial soap turning my skin pink. “Let me check your vitals and see if those lab results are back yet.”
The next hour moves fast. Meds, IV lines, anxious families who need to hear that their person is being seen even when science is working on its own schedule. Patience isn’t a common trait when someone you love is sick. I make sure everyone knows we’re on theirs.
At 4:15, Dr. Aubrey Fernandez emerges from Trauma 1 looking like she’s just gone three rounds with a particularly difficult diagnosis and won.
Sharp eyes behind wire-rimmed glasses, a no-nonsense demeanor that came from being one of the few women to fight her way up through emergency medicine in the nineties.
“Bradford.” She stops at the nurses’ station. “Please tell me you’ve got magic hands today because Bay 4’s cardiac workup is clean and he’s still convinced he’s dying.”
“That sounds like sure heartburn with a side of anxiety,” I say, pulling up his chart. “But I’ll work my charm.”
“Your charm.” She raises an eyebrow. “Is that what we’re calling your ability to talk patients down from the ledge?”
“I prefer to think of it as therapeutic honesty delivered with excellent bedside manner.”
Nate snorts without looking up from his computer. “Yesterday he told a guy quite bluntly that his ‘heart attack’ was actually because he ate an entire pizza in one sitting and then decided yard work was a good idea.”
“He was seventy-two and it’s August,” I point out. “I know people can be a bit stubborn, but someone had to explain from a place of concern that pepperoni and heat exhaustion don’t mix well. He thanked me for it.”
“That’s after he stopped being mad at you,” Nate adds. “Then he’s been asking for you ever since.”
“Details.” I wave my hand dismissively.
“Somehow these patients love you anyway.” Dr. Fernandez shakes her head, but she’s almost smiling. “Bay 4. Go work your therapeutic honesty on him before he demands to see a cardiologist.”
“You got it, boss.” I pick up the chart and stand.
The ED has filled up by the time I’m charting the meds I’ve given.
Tall brunette Charlie appears, materializing at my side as nurses do when they’re ready to unload whatever personal or professional drama they’ve been holding on to.
She’s competent, quick, and has a habit of circling back to the same conversation whenever things slow down.
“Did George bring you coffee yesterday morning on your day shift?” she asks, batting her eyelashes. I already know where this is going, with versions of this conversation played out more times than I can count over the past six months.
I keep my eyes on the screen, typing notes with the focus this job demands. “Yes, he did. As usual, when I do days and he’s on his way to clients for home service.”
She sighs dreamily. “He’s not seeing someone yet, is he?”
“Not that I know of. He’s married to the shop. Spends most of his time covered in grease, sleeves rolled up, working on engines.”
Charlie sighs again, color rising in her cheeks, clearly picturing exactly what I just described. I catch myself doing the same thing and type something wrong. I delete it without looking up.
“You should set us up,” she says. Same request and hopeful expression. Same number of times I’ve deflected it.
Nate strolls in from one of the cubicles and catches the tail end of it. He snorts.
“Charlie, just ask the man out yourself.”
“What if he says no?” She’s twirling a strand of dark hair around her finger. “It’d be so awkward.”
“You’d survive and move on like a functional adult,” I say, closing the chart and pulling up the next patient. “George can handle being asked on a date.”
They’re both looking at me. I realize I said it with more edge than I meant.
“Someone woke up on the wrong side of the bed,” Charlie says, narrowing her eyes.
“I’m fine, my friend.” I grab the chart and stand. “Bay nine needs sutures. I’ll go get Dr. Fernandez.”
I slip away, heading toward the station cupboards to grab some supplies, forcing my mind elsewhere. George is my friend. If he wants to date someone, that’s his business. I should have no say.
The next two hours move in constant motion.
I assist Dr. Fernandez with a chest tube insertion on a man who spent a weekend doing intense rock climbing and tried to manage his own collapsed lung.
I restart a second IV on the chest pain patient when his first one infiltrates.
I walk Josh through wound prep and irrigation with the patience of someone who remembers being that green and terrified.
At 6:47 PM, the radio crackles.
“SDMC, this is Medic 47. Eight minutes out with two adult patients from an MVA. First patient is a seventy-eight-year-old female, altered mental status, possible head injury. Second is a forty-five-year-old female, stable vitals, possible wrist fracture. Requesting bed assignment.”
Nate is already coordinating. “Bring the elderly female to trauma one. Wrist fracture to Bay 10.”
Dr. Fernandez appears, already donning a trauma gown. “I’ll take Trauma 1. Bradford, standby for overflow.”
I nod and stay ready at the nurses’ station.
The next few minutes move through the familiar choreography of incoming trauma.
I’m starting to relax when my phone buzzes in my pocket.
Once, twice, three times in rapid succession.
I pull it out long enough to see three missed calls from an unknown number.
I’m about to call right back when the radio crackles again.
“SDMC, this is Medic 63. Five minutes out with a thirty-one-year-old male, work-related injury, deep lacerations to the right thigh and possible right hand fracture. Patient is conscious, hypotensive, actively bleeding.”
“Copy that,” Nate says. “Trauma 2 is open. Lance, you’re up.”
My phone buzzes again, pressing into my leg. I ignore it and move to prep. The IV poles extended, monitor leads laid out, trauma cart in position. I check the equipment, verify everything is in reach, then glove up.
I position myself at the entrance to Trauma 2. Through the glass I can see the flash of red and blue lights as the ambulances pull into the bay.
The first gurney bursts through at exactly 6:55, paramedics wheeling the elderly woman toward Trauma 1, calling out vitals and suspected injuries.
Dr. Fernandez and her team swarm the patient immediately, hands and voices working in the synchronized shorthand of people who’ve done this a thousand times.
The second gurney is heading straight for me.
A large male form, one thigh wrapped in blood-soaked gauze, wheels through the doors. I’m already running through trauma ABCs, moving with the clinical calm that years of practice builds into muscle memory, when I try to argue with what I’m seeing.
The paramedic is already calling out the report. “George Torres-Macklin, thirty-one-year-old male—”
Everything in me seizes for a second.
“—Deep lacerations to right thigh, right hand with possible fracture, work-related injury—”
There’s blood where there shouldn’t be blood, leg wrapped, hand wrong, and my brain refuses to catch up.
I can’t breathe. My pulse jumps hard and high, throwing off my rhythm. There’s a sharp, useless spike of panic that has no place in this room, not with him lying there.
Then it snaps.
George needs me.
I drag in a breath and force myself to step forward. My face goes blank, locked down, exactly how it needs to be.
I’m already at the gurney, running a fast clinical sweep over the gauze on his thigh, the pallor in his face, and the blood pressure reading on the portable monitor. I take in everything I need in those few seconds and keep moving.
George looks up at me.
“Hey,” he says, trying a little too hard to sound okay for a man who’s hypotensive and losing blood. That’s so completely him it almost undoes me.
“Hey, Big Guy. I’ve got you.” I say softly, more affection slipping through than I intend, forcing on the voice I use when a room needs to believe everything is under control. “Try not to bleed out dramatically on me, okay? I just did my nails.”