Chapter Text
The email comes through at 11:42 p.m.
Dennis is sitting at a campus library computer fifteen minutes before closing, pretending he isn’t watching the clock in the corner of the screen. His backpack is hooked around his ankle — habit, more than paranoia. Everything he owns fits inside it. Laptop. Two changes of clothes. A paperback anatomy review book. The prepaid phone he keeps on silent so the battery lasts longer. All the way at the bottom, a bible.
The librarian announces closing in fifteen minutes.
His inbox refreshes automatically.
Subject: Rotation Adjustment – Immediate.
He frowns.
Clicks.
Due to unforeseen staffing shortages, Presbyterian has transferred your Emergency Department rotation to Pittsburgh Trauma Medical Center effective tomorrow.
Report 0700.
Attending: Dr. Michael Robinavitch.
The cursor blinks beneath the message.
Dennis doesn’t move.
PTMC.
Robinavitch.
The overhead lights flicker as half the rows shut down for the night.
His stomach drops.
He exits the email, logs out of the library computer, and shoves everything back into his bag in one smooth motion.
Outside, the air is sharp. Early fall cold.
He walks two blocks before stopping beneath a streetlamp and pulling out his phone.
The screen is spiderwebbed at the corner from when he dropped it last month. The plastic case doesn’t quite snap shut anymore. It’s a prepaid model bought with cash at a gas station, number changed twice since he began med school.
He scrolls to Robby’s name.
Hesitates.
He presses call.
The phone rings once. Twice.
Static crackles through the speaker. A metallic hiss. On the third ring the screen freezes.
Dennis taps it.
Nothing.
“Come on,” he mutters.
The line clicks — not a voicemail, not an answer. Just dead air. The screen goes black.
He presses the power button. No response. Presses again.
A faint flicker — then nothing.
The battery indicator had been at eighteen percent. Now it won’t turn back on.
Dennis stands under the streetlight, heart racing.
He shakes it once. Stupid. Futile.
Tries holding the power and volume buttons together. A trick he learned months ago.
Still nothing.
A car passes. Headlights flare and fade.
He lowers the phone slowly.
There’s no way to warn them now.
No way to prepare the room.
He tells himself it doesn’t matter.
They’re adults. Professionals.
But the thought of Robby seeing his name on the roster without warning makes his chest tighten.
He tucks the dead phone back into his pocket.
The bus stop bench a block away is already occupied. Two men bundled in coats. A woman asleep against the glass.
He keeps walking.
Hospital waiting rooms don’t close.
By 1am he’s in one — not PTMC, not Presbyterian. A smaller community hospital three neighborhoods over. He sits near the far wall beneath a television playing muted news.
He doesn’t check in.
Doesn’t make eye contact.
Just lowers himself into a chair and pulls out his anatomy book, reading under fluorescent light that hums like it’s tired too.
Around 2 a.m., he sleeps sitting up.
Backpack looped through his arm.
Alarm set on a phone that might not turn back on.
At 4:37 a.m., he wakes in a jolt, disoriented, convinced he’s missed something.
For a moment he doesn’t remember the email.
Then it lands.
PTMC.
Dr. Michael Robinavitch.
He fishes the phone from his pocket. Holds the button again. The screen flickers.
Stays dark.
“Fine,” he whispers.
He stands, shoulders stiff from the chair, and heads for the bus.
He will walk into the ED without warning.
Without preparation.
Without a working phone.
Without a home.
And when Robby looks up and sees him —
The collision will be unavoidable.
The ED at PTMC is louder than the one he’d found solace in last night.
Not just in decibels — in energy.
Fluorescent lights hum. Monitors beep in asynchronous rhythm. The waiting room is already full, and it’s barely dawn.
Dennis adjusts his scrubs. He signs in.
The board reads:
Attending: M. Robinavitch
His pulse spikes.
He tells himself this is professional. Manageable. Adult.
The elevator doors open. Voices spill out before bodies do.
Dennis steps aside instinctively, half-hidden behind a column near the nurses’ station. He isn’t trying to eavesdrop. He just isn’t ready to be seen.
Jack exits first, coffee in hand, eyes strained like he hasn’t slept. Robby follows, already skimming a tablet, thumb moving in quick, efficient swipes.
Jack says, “Oh, and you’ve got the med students and new interns starting today, so good luck with that.”
Robby exhales through his nose. “Lucky, lucky me.”
“There’s been a change though—”
He’s cut off by a voice bright with caffeine and ambition.
“Dr. Robinavitch?”
Robby looks up immediately. Warm smile. Professional ease sliding into place like armor. “Yep.”
A young intern is already extending her hand. “Melissa King. I’ll be joining you today. I just came off two months at the VA.”
“Hey, welcome to the Pitt,” Robby says. “This is Dr. Jack Abbot.”
“Nice to meet you. I can’t tell you how excited I am to be here today, so—”
“Talk to me at the end of the day,” Jack says dryly. Despite his anxiety, Dennis can’t help it when his mouth curves up slightly. He’s grown fond of Jack's dry sarcasm.
He sees Robby bump his shoulder lightly. “Ignore him. He had a rough night and is having an ongoing existential crisis.”
“Don’t worry,” Jack adds. “You’ll get there soon enough.”
Mel laughs nervously.
Dennis watches from the edge of the room as more students cluster in. Introductions ricochet around the desk.
Names.
Schools.
Intended specialties.
Robby nods at each one, committing them to memory.
Then his eyes land on Dennis.
They don’t widen. They don’t warm. They simply register. Professional. Contained.
Dennis steps forward because he has to.
“Uh. Dennis Whitaker. MS4.”
Robby glances at his badge. “Whitaker,” he repeats evenly, finally filing away his last name. “Welcome.”
No pause.
No flicker.
Dennis almost stumbles from the normalcy of it.
“All right,” Robby says, clapping once. “Here’s how this works. You don’t stand in corners. You don’t freeze. You don’t disappear when it gets loud. If you don’t know something, you say so. If you think you know something, you verify it.”
His eyes sweep the group.
“We take care of patients. We take care of each other. In that order.”
Dennis feels the words like a current under his skin.
We take care of each other.
The board dings.
Ambulance inbound.
“Welcome to The Pitt,” Robby mutters.
And the chaos begins.
It’s relentless.
A non-English speaking woman with a degloved foot in Trauma 1.
Psych hold screaming incoherently in BH.
An elderly woman unresponsive and hooked up to LUCAS.
Dennis barely has time to think about the fact that Robby’s voice carries differently here — sharper, faster, edged with command. In a rushed moment, Dennis hurts his finger while transferring a patient.
He can’t stop from crying out.
“Students are dropping like flies,” Langdon observes, referring to another student who had passed out earlier.
“Whitaker,” Robby calls without looking at him. “Take a break. Ice the finger.”
Efficient. Nothing personal.
Everything intimate.
At one point Robby brushes past him in a narrow doorway, shoulder grazing shoulder. It’s incidental.
It feels seismic.
By early morning, Jack is gone.
But not before catching Dennis in a side corridor near radiology.
The hallway is dimmer, quieter — a pocket carved out of the storm.
Jack steps into it as Dennis exits CT.
Not touching.
Not close enough to imply anything.
“Hydrate,” Jack says quietly.
“I’m fine.”
“You’re not.”
The same words as weeks ago.
Dennis’s throat tightens.
“Your pulse says otherwise,” Jack continues.
Dennis almost laughs at the absurdity.
Of course he would notice.
“Eight weeks,” Jack says. "We'll get past this."
“Yes, sir.”
The word slips out before Dennis can stop it.
Jack’s jaw tightens — just barely.
“This is not that,” he says quietly.
Dennis nods. “I know.”
Jack studies him — not possessive, not hungry. Just assessing.
“You look thinner again.”
“Rotations.”
“Neglect,” Jack corrects gently. His gaze lingers at Dennis’s throat for half a second too long before flicking back to his eyes. Clinical. Probably.
A beat.
“You cannot afford to unravel here,” Jack adds.
“I won’t.”
“That wasn’t reassurance,” Jack says. “That was deflection.”
Dennis feels heat rise to his face.
Jack steps back, reestablishing distance.
“Professional distance is not punishment,” he says evenly. “It’s preservation.”
Dennis nods again.
Jack’s gaze softens a fraction. “Eat something.”
Then he turns and disappears down the hall.
The code had run long enough that time bent around it.
Dennis knows the moment. Everyone in the room knows it.
The rhythm on the monitor dissolves into a flat, unconvincing line. The chest under his palms had already lost the recoil of life and taken on the compliance of something mechanical. But Robby doesn’t call it.
“It's been four minutes since the last epi. One more minute, please,” Dennis says frantically. Dr. Robby nods.
So Dennis keeps going.
He compresses until his shoulders burn. He refuses to switch out when told. He pushes epinephrine. He repeats pulse checks with hands that were already trembling. He searches for something reversible — tension pneumothorax, tamponade, massive PE — anything that would make this salvageable instead of senseless.
Nothing appears.
The room thins out gradually. The urgency softens at the edges. The nurse stops drawing up meds before being asked. Mel slows the bag pushing air into Mr. Milton’s non-breathing lungs.
Finally, Robby glanced at the monitor.
“OK, that's it. Hold compressions.”
The words drop into the space and stay there.
Dennis’ hands are still on the patient’s sternum.
He doesn’t move until Mel gently says, “Hey.”
He steps back like he’d been caught doing something wrong.
They gather shortly after in the small alcove around the patient. The ED had already swallowed the loss and moved on — another ambulance backing in, another triage complaint populating the board.
Robby leans against the wall, arms folded loosely.
“OK,” he said. “What else? What else went well?”
Mel clears her throat. “We checked for reversible causes of cardiac arrest on ultrasound.”
“OK, good.” Robby nods. “That’s important. Does anybody have anything that they wish had gone differently?”
Dennis doesn’t mean to speak first.
“In the hall,” his voice flat, “he should have been on a cardiac monitor. We would have caught the arrest right away.”
A couple of heads turn.
Robby doesn’t flinch. “That’s true,” he says evenly, “but there was no indication for monitoring. And we now know that his abdominal pain was not from his gallstones but from unstable angina due to coronary artery disease.”
Dennis feels heat climb his neck.
“Then we should have admitted to cardiology.”
A pause.
“Mm,” Robby says gently. “We did an EKG. We did a troponin. He had a HEART score of three. Who can tell me what that means?”
Langdon answers first. “One percent chance of an adverse cardiac event in the next thirty days.”
Collins adds, “Standard of care is to discharge with outpatient follow-up.”
Robby nods. “Right.”
The fluorescent lights hum. Somewhere behind them, someone laughs at something unrelated. A monitor chimes for another patient.
Robby’s eyes settle on Dennis.
“He was your patient, Dr. Whitaker. Would you like to say something before we all take a brief moment of silent reflection?”
The title lands harder than it should have. Student. Student doctor. Don’t put your faith in me.
Dennis swallows.
“Um… He liked Kentucky bourbon.”
A few startled glances. Robby blinks — then huffs a soft laugh.
“OK, good. Me too.” He tilts his head. “Anything else?”
Dennis stares at the scuffed tile floor.
“I don’t know. I just met him. No, he seemed nice. He was married. Um, that’s it. That’s all I got. I…”
His voice trails off, unfinished.
Robby lets the silence sit.
“Alright,” he says quietly. “Let’s take a moment.”
They bow their heads. Not long. Just enough to acknowledge that a person had occupied space here and now did not.
The spell breaks.
Monitors chime. Someone is called to trauma bay two. The group disperses in different directions, already reabsorbed by the machine.
Dennis stays where he was.
Robby steps into his periphery.
“Hey, Whitaker.”
Dennis looks up.
Robby’s voice drops, softer now. Not attending-to-student. Not in front of an audience.
“How are you feeling on this?”
Dennis lets out a breath that wasn’t quite a laugh. “I mean, not good. I was just talking to him. Now he’s dead.”
Robby nods once. “That’s the hardest way to lose a patient. It always hurts.”
Dennis is already shaking his head. “Especially when it’s your fault.”
Robby’s expression sharpens immediately.
“This was not your fault,” he says. Firm. “This was nobody’s fault. No doctor on the planet could have caught this. Listen — it sucks, but today? Today was this guy’s day to leave this mortal coil. A hundred and fifty thousand people die every day in the world, and you got one of them.”
Dennis looks away.
“You learn to live with it,” Robby continues. “You learn to accept it as much as your own mortality and find balance if you can.”
Dennis studies him, knowing. “You’ve found balance?”
A corner of Robby’s mouth twitches. “No. Not even close.” He shrugs lightly. “But, you know, you keep trying, which is all you can do. You’re doing great, Whitaker. Just… hang in there.”
There it was again.
You’re doing great.
Dennis doesn’t feel great. He feels hollowed out and vibrating at the same time.
“Yeah,” he says. “Thanks.”
Robby lifts his hand.
It’s instinctive — Dennis can see it. The familiar motion, the reassuring weight that would have landed at the back of his neck, grounding and warm and impossible to misinterpret in any other context.
Halfway there, Robby remembers where they are. The hand stalls in midair.
For a split second, Dennis thinks — just do it.
But Robby’s eyes flick sideways. People move around them. Interns charting. Nurses passing through.
The hand drops.
“OK,” Robby sighs, stepping back. “I’m just gonna go.”
“Yeah.”
They turn at the same time and nearly collide — shoulder brushing shoulder. Both startle.
“Sorry,” Dennis mutters.
Robby exhales a quick, awkward breath. “But, you know, our social worker, Kiara, is here if you want to talk.”
Professional. Safe.
“OK,” Dennis says. “Yeah.”
They split in opposite directions.
Dennis walks back toward the workstation, vision narrowing slightly at the edges.
His hands still remember the resistance of the patient’s chest. His brain replays the timeline like a prosecutor.
Abdominal pain. Gallstones. Normal EKG. Troponin negative. HEART score three. Standard of care. Standard of care. Standard of care.
He sits down. The computer screen glows.
He stares at the chart and feels something inside him tilt — not grief exactly, not just guilt. Something sharper.
Jack’s voice echoes from earlier in the hallway.
Eight weeks.
This is not that.
Dennis flexed his fingers once, grounding himself against the desk.
He would not spiral.
He would not make this about penance.
He would learn. He would adjust. He would be better next time.
Across the department, Robby laughs at something Mel said — easy, unguarded. The sound carries.
Dennis doesn’t look up. He keeps working.
Whitaker keeps his head down through the early afternoon. Dr. Samira Mohan, a third-year resident, keeps him moving. She challenges him to take the most difficult patient next. And then another.
Samira scans the board, then jerks her chin toward the next room.
“Dennis Whitaker,” she says as they walk in, “meet Bob Chazen, a fifty-three-year-old cyclist who injured his leg about ten days ago on a trip to Utah.”
Bob is wiry, sun-leathered, irritated.
“I was in Moab,” he says, “coming downhill fast, and jammed my pedal into my leg.”
“Ooh,” Dennis says, crouching to examine the calf. “Ouch. That’s some gnarly road rash.”
“White Rim Trail,” Bob says, proud despite himself. “I’ve been putting Neosporin on it a couple times a day, but now it hurts to walk.”
Samira folds her arms. “What do you see, Whitaker?”
Dennis studies the wound. The edges are erythematous, warm.
“Um, outside of the wound looks cellulitic.”
Bob frowns. “What’s that?”
“It’s a bacterial infection,” Dennis explains. “We’ll need to get you on oral antibiotics.”
“Figured.”
Samira nods slightly. “What about the center of the wound?”
Dennis leans closer. A tense, dark blister domes over the deeper abrasion.
“Uh, it’s a simple hematoma.”
“Which you can now debride,” Samira says. “Whitaker will take off the dead skin covering the blister to help it heal better. I’ll be right back.”
“Yeah, uh, quick question—”
“Get some Iris scissors, toothed forceps, sterile gauze.”
“No, it’s just, um… Blister guy? Really?”
“Mr. Chazen was the next patient on deck.”
“I know I screwed up earlier.”
Samira’s gaze sharpens. “You didn’t screw up. The patient died. It happens.” A beat. “Just don’t amputate Mr. Chazen’s leg.”
“Okay.”
She leaves without another word. Dennis turns toward the patient.
”Hey.”
Bob eyes him. “Is this gonna hurt?”
“Oh, no,” Dennis says, snapping on gloves. “Skin’s dead. You won’t feel a thing. First time in Moab?”
“No, no. I belong to a club — Gears and Beers. We started riding to Frick Park during the pandemic… you know, just something to do to get out of the house. But we all stuck with it, and now we go on biking trips.”
“Huh,” Dennis says, positioning the scissors. “That’s—”
He lifts the edge of the blister.
“—Ahh! Ahh—”
The wall behind him is splashed in red. As are his scrubs. His face.
A thin, high-pressure stream shoots past his shoulder and splashes violently across the drywall.
Bob yelps. “Oh! Whoa, oh! Help! Do something, man!”
“Um—”
“—Oh!”
“Uh—”
“Dude! Oh, ow!”
Dennis clamps down instinctively over the source, fingers digging hard into slick tissue.
“I need a little help in here! Jesus!”
Mel appears in the doorway. “Hey. What’s up?”
“Arterial pumper under a blood blister.”
“Let’s see.”
Dennis shifts slightly and the stream pulses again.
“Oh.”
“Jesus!” Bob gasps.
“Oh, God,” Dennis mutters.
Garcia, passing by, glances in. “Noob.”
“Hi,” Mel says calmly, stepping in. “I’m Dr. King. Um, we can fix this.”
“Did you cut an artery?” Bob demands.
“No, no,” Dennis says quickly. “I punctured the top of the blood blister, but there was an artery hiding under there.”
“Hiding?” Bob stares at him. “Like… like you didn’t know it was there? Don’t you have to know basic anatomy to become a doctor?”
Mel answers smoothly. “He’s a student doctor.”
“What the fuck? Student? Oh, hell, no. No, no, no. Can— can you help me? Can you fix it?”
“Oh, absolutely,” Mel says. “First, we are going to put this BP cuff on to stop the bleeding. A little forward. There we go. All right, you can let go.”
Dennis eases pressure cautiously.
“Yeah?”
“Mm-hmm.”
“Thank God,” he breathes.
“Oh, thank God,” Bob echoes.
“All right, Whitaker,” Mel says, already moving. “Ten ccs of one percent lidocaine with epi.”
“Yep.”
“The shot is gonna numb the area and also constrict any blood vessels so that we can put a little stitch in there.”
Samira re-enters mid-scene. “What happened in here?”
Mel doesn’t look up. “Hidden laceration of an arteriole under the vesicle. Bleeding stopped at one-eighty on the BP cuff, and we are now injecting lidocaine with epi.”
“Thank you, Dr. King,” Samira says. “Let’s set up a suture tray with three-oh nylon.”
“Okay.” Dennis steadies his hands. “A pinprick and some burning—”
“Doc, Doc,” Bob says urgently. “Can you step in here, please?”
Samira meets Dennis’ eyes. “You got this, Whitaker.”
They work quickly. The vessel is isolated, tied off cleanly. The bleeding stops for good.
Dennis exhales.
The door opens.
Robby steps in, taking in the arterial mural behind Dennis, the soaked scrubs, the organized calm settling over the room.
His eyebrows lift.
“What did I miss in here?”
Dennis flushes under the blood.
“I am so sorry. I— I just…”
Samira cuts in smoothly. “Made an excellent catch and saved Mr. Chazen’s life.”
Robby glances between them. “Really?”
Bob sputters. “Really?”
Dennis blinks. “Really?”
Samira nods. “There was a cut arteriole under a ballotable vesicle. If Mr. Chazen had gone home without debridement, the blister could have eroded with uncontrollable hemorrhage.”
Robby’s expression shifts — genuine approval, quick and bright.
“Nice work,” he says. Then gestures to Dennis’ chest and the wall behind him. “Jackson Pollock here might want to go hit the scrubs exchange.”
Dennis nods, heat rising to his face.
“Yeah.”
He doesn’t wait for whatever else Robby might say.
He makes it back to the floor in clean scrubs just as a team of EMTs wheel in a bleeding 17-year old boy..
“Got a post-tonsillectomy hemorrhage. Nebulized TXA, quick as you can.”
Robby appears at his elbow almost instantly, plucking him from his path toward the board.
“Let’s go, Trauma 2.”
Dennis falls into step beside him automatically.
Right before they push through the double doors, Robby catches his sleeve and pulls him half a pace to the side. Not dramatic. Not obvious. Just enough to create a pocket of space.
His voice lowers.
“So this can go south pretty quickly, Whitaker. You up for it?”
Dennis’ mouth goes dry.
“Well, I can—”
Robby doesn’t let him finish.
“Of course you are.”
It’s not a question. Robby pushes him through the doors.
He gets covered in blood again.
The new scrub pants are a size too short.
He knows it before he ties them — the elastic biting higher on his waist than it should, the hem hovering just above his ankles like he borrowed them from pediatrics. The top pulls tight across his shoulders when he moves.
Fourth exchange of the day. Or is it fifth? He’s lost count.
He pushes through the double doors back into the ED, the fluorescent hum swallowing him whole again.
“Hey, you missed the best action of the day.”
Trinity Santos falls into step beside him like she planned it. First day badge still stiff and over-laminated. Hair pulled back too tight. Expression already calibrated somewhere between bored and predatory.
Whitaker doesn’t break stride. “I heard. What happened?”
“Father of the brain-dead son goes after another patient he thinks gave his son the drugs that killed him.”
Whitaker winces. “Jesus. How do you deal with that?”
Santos snorts. “No fucking idea.” She glances sideways at him — slow, assessing. “Whoa, what happened here? Did we have an accident?”
Her eyes drop to the hem of his pants.
He sighs. “Do you think I'm wearing this by choice?”
She leans closer, stage-whispering. “Was it number one or number two?”
“I just got some stuff spilled on me.”
“Was it a bodily fluid, and was it yours?”
“No and no.”
She studies him for another beat, then tilts her head. “Oh, is it from when you killed that guy?”
He stops walking.
“I did not— that guy had a massive MI in his sleep.”
His voice comes out sharper than he means it to. Santos’ mouth twitches.
“Relax, Huckleberry, I'm just fucking with you.” She bumps his shoulder lightly with hers — not gentle, not cruel. “Truth is, you're not a real doctor until you've lost at least one patient. You got off easy. It wasn't your fault.”
The words land heavier than the joke.
She looks straight ahead now, tone flattening just slightly.
“Not all of us can take comfort in saying that.”
There’s something there — a door she doesn’t open. Then she snaps it shut.
“But try not to kill anybody else.”
Whitaker exhales through his nose despite himself.
“I’ll add it to my to-do list.”
“Good,” she says briskly. “Because I’m not letting you tap out before I decide whether I like you.”
She peels off toward the workstation without another glance.
Whitaker stands there a second longer, feeling the too-tight fabric at his shoulders, the ghost-weight of the morning still pressing at his ribs.
Then he moves. Real doctor, apparently.
Dennis avoids Robby more deliberately after the tonsillectomy hemorrhage.
Patients chosen from the board on opposite sides of the ED. Questions routed sideways. If Robby enters a hallway, Dennis finds a reason to exit it. It’s almost working.
A nurse taps his shoulder.
“Your friend in Behavioral Health is asking for you.”
Dennis stiffens. “Which friend?”
“The one who baptized you earlier.”
He exhales once and heads toward the Behavioral Health room, not looking forward to facing the reason for one of his many scrub changes again today.
He steps inside cautiously. Mr. Krakozhia is pacing when Dennis walks in. Security lingers outside.
“Hey, man,” he says.
“It’s Dennis Whitaker.”
“Right. Dennis. I just wanted to say sorry for earlier. Heard I got you pretty good.”
“Yeah.”
Mr. Krakozhia rubs the back of his neck. “I kind of go out of my head when I’m off my meds. Then I guess I piss on people.”
“I’m pretty sure the meth doesn’t help.”
“I’m not using anymore,” he says quickly. “I take antipsychotics for the schizophrenia I got from doing meth. But I’ve been clean a year.”
Dennis pauses.
“Why aren’t you taking your meds?”
Mr. Krakozhia lets out a humorless laugh. “Why don’t I take my meds? Well, Doc, I’m kind of in between houses right now. Living in an encampment on Liberty Avenue. Meds cost money. I don’t have insurance. Should I go on?”
Dennis’s jaw tightens. In between houses.
He pictures his own storage unit. The frayed backpack that fits everything he owns. The prepaid phone with the cracked corner and minutes he rations like oxygen. He pictures the nights he’s slept in the hospital call room under the excuse of studying. The abandoned wing of this very hospital he’d had the luxury of calling ‘home’ for a couple months during a PICU rotation his M3 year.
He imagines one bad month. One unexpected expense. It wouldn’t take much.
He could be sitting on that stretcher Mr. Krakhozia had been strapped to earlier.
“No. No, that’s fine. I’m sorry. Life isn’t always easy. Have you talked to a social worker yet?”
“No.”
“OK.” He turns to the nurse in the doorway. “Do you think you could go grab—”
“Kiara?” She supplies.
“Kiara in here?”
“Yeah.”
Mr. Krakozhia looks back at Dennis. “I really am sorry.”
“It’s OK,” Dennis says, and this time he means it. “Honestly. Really, it’s OK. I appreciate the apology.”
Kiara slips in with her usual steady warmth.
Dennis launches in, focused.
“Mr. Krakozhia, here’s my obvious concern. I write you a script for thirty days’ worth of pills. Then what?”
“What do you mean? I’ll take them.”
“Well, you come back for thirty more, right? I mean, that’s the question. Even if I could give you your dose in a once-a-month shot, you still have to come back when the month is over.”
Kiara tilts her head. “What if he didn’t have to?”
Dennis frowns. “Oh, no. He has to. If he doesn’t, he… well, he pees.”
Kiara smiles faintly. “We have a street team here. Mr. Krakozhia, are you pretty much in one spot these days?”
“Yeah, I’m over on Liberty near the Benedum.”
“The alley? I know it well.”
Dennis looks between them. “So we could bring the meds to him?”
“Absolutely,” Kiara says. “The once-a-month injection sounds like the easier option. We could just put you on our schedule.”
Something inside him shifts — not dramatic, not cinematic. Just a small internal realignment.
There are systems here he didn’t know existed.
Street teams. Medication delivery. Case management that extends beyond discharge papers and good intentions.
He’s been working in this field for months, years. He didn’t know. And the knowledge lands strangely.
Part of him is relieved — for Mr. Krakozhia, for the proof that the hospital isn’t just fluorescent lights and billing codes.
Part of him aches.
He could have used this.
Not the injection. But the knowing. The idea that there were people whose entire job was to bridge the gap between collapse and stability. That “in between houses” didn’t automatically mean invisible.
Would he have taken it?
He isn’t sure.
The thought of Kiara knowing. Of Jack knowing. Of Robby knowing.
The thought of anyone at the hospital understanding that he showers in the sink some mornings because it’s easier than explaining why he can’t go home.
No.
He doesn’t think he would have told them. Especially not his attendings.
Jack, who sees too much already.
Robby, whose praise feels like something Dennis isn’t certain he deserves to keep.
“I’d be interested in joining that,” he says. “Maybe I can bring out the medicine myself.”
Kiara’s eyes light up. “That’d be amazing. We could use all the help we can get.”
Mr. Krakozhia smiles — small, real. “Thanks, Doc.”
Dennis nods.
He doesn’t say: I get it.
He doesn’t say: I’m closer to you than you think.
They step out into the hallway.
Kiara studies him.
“You were good with him.”
Dennis shrugs. “Do you get a lot of homeless in Pittsburgh?”
“We call them unhoused,” she says gently. “It’s not as bad as Philly or D.C., but it’s still pretty bad.”
“Yeah.”
“It really is great that you want to help out. The street team gets cool jackets.”
He huffs a soft laugh. “Yeah?”
“Come find me end of shift and I’ll give you more information.”
“Will do.”
A nurse passing by grins at him. “You made it out unscathed this time.”
Dennis glances down at his scrubs.
Clean. For now.
“Yeah,” he says. “I’m joining the street team. Even get a jacket, so…”
“Cool.”
He nods. “Yeah. It is cool. Very cool.”
Across the department, Robby looks up from a chart.
Their eyes almost meet.
Dennis looks away first, afraid Robby might see right through him.
And if Robby saw the reflection — the thin line between doctor and patient, between housed and unhoused — Dennis isn’t sure he could keep pretending that line is solid.
The afternoon sours by degrees. Not for Dennis, but the patients.
The waiting room monitor creeps past a four hour wait for most visits. Then five.
Every conversation at triage starts the same way — tight smile, controlled voice — and ends one notch louder. There aren’t enough rooms. There aren’t enough stretchers. There aren’t enough nurses. The board is a grid of red and yellow, names stacking faster than they clear.
Dennis and his colleagues move from complaint to complaint, absorbing it.
“My chest pain is worse now.”
“I’ve been here all day.”
“Are you people even doing anything back there?”
They are.
That’s the worst part. They are.
Around four, the simmer breaks.
It happens fast — a raised voice in the ambulance bay, Dana’s firm, practiced cadence in response — and then a crack of impact that doesn’t belong in a hospital.
Dennis turns in time to see Dana stumble in through the ambulance bay doors, blood soaking her face and scrubs.
“Don't, don't, don't! Don't touch me! I'm fine.” She insists, hands up as Robby sprints towards her. Dennis’ heart flutters and he refuses to look into that.
“Jesus fucking Christ!” Robby exclaims, a little frantic.
“Just got punched. Just took a fall. OK. I'm fine.” She insists, trying to push Robby away. “Just an unhappy patient.”
Her cheek is already blooming purple.
The department exhales, then keeps moving. Shift end becomes a rumor people cling to.
“Three more hours.”
“Two and a half.”
“I’m not staying late. I swear to God.”
Dennis says none of it, but he hears it. The quiet math everyone’s doing in their heads — if nothing else goes wrong.
For the first time all day, he finds himself alone at the workstation.
The board is momentarily stable. No one actively coding. No one actively bleeding. He leans back in the chair and lets his shoulders drop.
It’s been a nightmare.
Blood on his chest. Urine down his pants. A man dying minutes after he spoke to him about bourbon. Dana getting punched. The constant friction of people at their worst colliding with a system at its limits.
And yet.
Underneath the exhaustion, something else hums.
He felt useful today.
Not in the abstract, not in the “good job, med student” way.
Useful.
He caught the arteriole. He stayed steady with Mr. Krakozhia. He didn’t fold when things went sideways. Even losing Mr. Milton — God, that hurt — but he stayed in the room. He learned. He didn’t run.
The realization comes quietly and hits harder than the sucker punch.
After a year of rotations — surgery’s bravado, internal medicine’s endless rounding, pediatrics’ forced cheer — this might be it.
This chaos. This immediacy. This awful, electric middle of everything.
Emergency medicine.
He startles at himself.
Intern year. Applications. Staying here.
What that would mean.
For Jack. For Robby. For whatever this fragile, undefined thing is that lives in glances and almost-touches and conversations that linger half a second too long.
He doesn’t let the thought finish.
The ambulance bay doors slam open once again.
Voices spill in — too loud, too sharp.
“…multiple victims—”
“…shots fired—”
“…festival—”
The overhead crackles.
“Code Triage, Emergency Department now. Code Triage, Emergency Department now.”
The room stills.
Santos looks up from the computer. “What's that mean? Has that happened before?”
Gloria from Administration appears like she’s been conjured, heels clicking with impossible calm. “We're locking down the hospital and setting up a command center in Administration. We'll coordinate logistics, supplies, communication.”
Dana, ice pack pressed to her cheek, doesn’t miss a beat. “How many casualties?”
“Unclear,” Gloria says. “But initial reports are not good.”
The waiting room is cleared in minutes. Patients protest, cry, demand answers. They’re herded toward other hospitals, urgent cares, anywhere but here.
Beds are stripped mid-visit. IVs capped. Discharge papers printed half-finished.
There’s nowhere to put the newly displaced.
Without thinking, Dennis says, “There's a whole wing that's empty on the eighth floor. I don't know if that's—”
“But no nurses to staff it,” Gloria cuts in. A beat.
Robby, from a few feet away: “No comment on that one.”
Even now. Dennis has heard his frustrated rants after a bad shift before. Knows he’s been arguing for more nurses, better pay, safer ratios for years. The joke lands hollow and true at the same time.
Then he shifts.
It’s visible — the pivot from frustrated attending to crisis leader.
“Waiting room and Triage can go to Family Medicine Urgent Care,” he says, already moving. “And we should turn off the TVs. We don't need to cause any extra panic.”
A tech reaches for the remotes.
“Keep the press out of here,” Robby adds.
Security nods and disperses. Robby turns to the room.
“OK, everybody listen up,” Robby calls, voice cutting clean through the noise. “There is an active shooter at PittFest. As the nearest trauma center, we are going to be getting the majority of the victims. We don't know yet how many we are getting, but we are instituting hospital-wide emergency protocols. We need to move every patient out of here. They either go home, they go upstairs, or they go to Family Medicine.”
The doors swing again.
Jack Abbot walks in, jacket half-zipped, earlier than his shift. He pauses just inside the threshold, letting his eyes adjust to the fluorescent glare before stripping off his sunglasses. For a split second, the overhead lights catch strangely in his irises — too reflective, almost metallic — then it’s gone. He makes calm eye contact with Robby as the latter continues speaking.
“Call your loved ones now if you need to. I can guarantee you cell service will soon be overwhelmed. Eat something. Stay hydrated. Use the bathroom while there's time and meet back here for a full briefing in five minutes.” He looks at Abbot. “Brother, I'm so fucking glad to see you.”
Abbot steps beside him, already scanning the room. “Heard it on the police scanner. How many we expecting?”
Robby shakes his head once. “I don't know, but it doesn't sound good.”
The department shifts again.
The countdown to shift end evaporates.
No one mentions going home.