Chapter Text
Garcia POV · July 6 · Present
The belly in bay six is not appendicitis, whatever the intern wrote in the chart.
“Walk me through it again,” Yolanda says, gloves on, hands already pressing the right lower quadrant while the patient—sixty-one, sweating, apologetic about it—watches her face for a verdict.
“Two days of pain, migrating, worse with movement.” Mel King has the presentation organized like a packed suitcase, everything folded, nothing extra. “White count’s fourteen. But I didn’t like the cecum on the CT, so.”
“So you called me instead of booking an OR at six in the morning on a hunch.” Yolanda palpates, watches the man’s face, releases. Rebound, but high. “Good. It’s not his appendix. Keep him NPO. I want to go through the CT with radiology first—I’ll put my note in before I leave.”
“Thank you, Dr. Garcia.”
“Don’t thank me, Sadness. I just took away your appendectomy.”
Mel does the small pleased thing she does when a nickname lands on her instead of past her, and Yolanda strips her gloves and steps out into the last hour of a night shift that has behaved itself. The ED has the quiet it only gets on a holiday weekend at dawn—board down to single digits, half the lights dimmed, Dana at the charge desk doing three things with two hands and making it look like rest.
Yolanda is not supposed to be down here. She’s supposed to be upstairs rounding on a grade-two splenic lac who had the good manners to stop bleeding on his own. But the consult page came, and she took the stairs, and if some part of her routes every errand through the ED these last two days—checks the assignment board she has no reason to check, reads the day-shift column for a name that isn’t on it—that part is not consulted about its motives. Santos is off today. Off tomorrow too. Yolanda knew that before she looked. She looked anyway.
Two days. It turns out not thinking about something is a procedure like any other… You do the steps in order. You don’t skip. You round, you chart, you take the consult. And when the Fourth tries to replay itself in the back of her head—Nadia with a stolen coffee saying the thing out loud like a lab value already resulted, and Santos at the ambulance bay eleven hours later with the fireworks starting somewhere past the parking structure, asking, actually asking, chin first, the way she never asks anyone for anything—Yolanda puts a task in front of it. The task absorbs the sound. Mostly. What she said to Santos took eight words. She’s had two days to admire the economy.
The radio at the triage desk opens up at 6:41. “PTMC, Medic 42. Multi-vehicle at Penn and Braddock, city bus versus box truck, bus took it broadside. Multiple patients, at least four critical, more ambulatory. First units out in six.”
The room changes before the transmission ends. It looks like people setting things down.
Dana is already up, disaster sheet in one hand, phone at her shoulder. “Perlah, clear two, three, and four. Jesse, hallway beds to the far wall. Somebody wake up the blood bank.” The overhead page goes out flat and unhurried—trauma team to the ED, multiple incoming—in the tone hospitals use so nobody runs.
“Do we divert?” one of the night residents asks. New enough to still ask.
“To where?” Dana doesn’t look up. “Westbridge is still closed. We’re it.”
Yolanda is at the desk without having decided to walk there. Upstairs there is a stable patient and a note to write; down here there are four criticals inbound. The backup attending is forty minutes out, the other fellow is at a lake with his kids, and nobody at the desk can tell her which of the borrowed Westbridge staff is covering surgery. She checks the board once. “Whoever’s available, page them down.” It isn’t a decision. It’s arithmetic.
“I’m here,” she tells Dana. “Bay two’s mine.”
Mateo hangs up the EMS phone with a look on his face that Yolanda will remember later in unhelpful detail. “Medic 42 says one of the criticals had a PTMC badge on her. They flagged it.” He says it to Dana, but the whole desk hears it. “It’s one of ours.”
The desk goes still for half a second, the way an OR goes still when the suction changes pitch.
“On her,” Dana repeats. “Female?”
“Possible. Didn’t say. That’s all they gave me.”
Yolanda stands very still and does not run the math. The math runs anyway, the way a monitor keeps counting whether or not you watch it. Who rides the bus at 6:40 a.m. Whitaker rides the bus—splits his nights between Robby’s place and the apartment, complains about the transfer at Negley like it’s a personality trait. Javadi rides it when her mother doesn’t drive her, which Javadi would rather die than admit. And Santos rides the bus every shift, because parking costs money and an R2 salary is an insult—Yolanda knows the route number. She knows which stanchion Santos leans against when the seats are full, because Santos told her once, at 2 a.m., in the dark, in the voice she uses when she thinks Yolanda’s asleep.
Female. Late twenties to thirties, if it’s who the math says it could be. Off today. She’d have no reason to be on that bus.
She’d have every reason. Errands. The gym. A holiday weekend, a city, a life Yolanda deleted herself from eight words at a time.
“Garcia.” Dana, quiet, watching her the way Dana watches everything. “You good?”
“Gowning,” Yolanda says, and goes.
The ED converts around her in ninety seconds—trays stacked, the ultrasound wheeled over from six, McKay appearing at the ambulance doors still shrugging into a yellow gown, called in early or never left, Yolanda doesn’t ask. Abbot comes down the hall from the night side, pulling gloves on, unhurried the way he is unhurried, which is not the same as slow.
“Heard we’ve got a badge in the mix,” he says.
“That’s the report.”
He looks at her for exactly one second longer than the sentence needs. Abbot has been doing this a long time. “Take the belly when it comes,” he says. “I’ve got the airway.”
The doors bang open on the first wave.
“Ambulatory to your left, three walking wounded!” a medic calls, already backing out for the next run. A man drifts to a chair with blood tracking down one temple, more outraged than hurt. “My glasses,” he says, to nobody in particular. “Does anybody see my glasses?”
“Sit,” Jesse tells him, unwrapping gauze. “We’ll find your glasses.”
Behind him, a board comes through fast—a woman collared, shouting a name that isn’t hers into the fluorescents, Marcy, Marcy, like the name might answer back. Perlah falls in beside the gurney at a jog, calling vitals over her shoulder without breaking stride. “Pressure’s holding. Bay four. We’re still assessing.”
“Copy, four.”
A third gurney clears the doors and goes quiet the second it does, which is the one that scares Yolanda most. A teenager, gray around the mouth, eyes tracking nothing. She’s at his side before she’s decided to be, two fingers at his wrist, counting.
“Rapid, thready.” She flags the resident over without waiting to see if he heard her. “Into three. Get him imaging. Not after the next one. Now.” She stays until the resident takes the wrist from her.
She works the wave after that—hands on one patient just long enough to know they can wait, eyes already clearing the next gurney, and the next, reading faces the way she reads films. Not Santos. Not Santos. A build like Whitaker’s—wrong jaw, wrong everything, and the relief lasts exactly as long as it takes to be wrong. Not Javadi. Not anyone she knows. Three ruled out, and her hands are no steadier for it. Four criticals, Medic 42 said, and she’s counted three gurneys through the doors.
“Where’s four?” she says, to whoever’s closest to the room.
Nobody answers her. Nobody’s supposed to. It’s not that kind of question.
“Garcia!” Abbot’s voice, from bay two, pitched to carry. “Need you. Now.”
She crosses the department in eleven steps, and the first thing that reaches her is Dana’s voice, low, bent close to the gurney: “Stay with me, Trinity. Come on, honey. Eyes open.”
Trinity. The word goes in and doesn’t attach to anything. The bay is already full and working—Abbot at the head with a jaw thrust, calling for suction; Mateo cutting for a second line; and on the gurney a woman, late twenties, collared, a dressing taped high on the forehead, face turned away and half-gone under blood and an oxygen mask. Sheet gone brown at the flank. Belly distending while Yolanda watches. It could be anyone. Blood rearranges faces. It could be anyone.
“It’s Santos,” McKay says from the monitor, making room at the rail, and she says it gently, which is a data point Yolanda registers and declines to interpret. “Pressure’s 84 over 50, heart rate 132. She was in and out the whole ride.”
Somebody is wrong. That’s the position Yolanda’s brain takes, without consulting her. Santos is off today. Off tomorrow. She has no reason to be on that bus, and the face is turned away, and half the city is female and late twenties. Yolanda puts her hands on the abdomen—rigid, guarding in all four quadrants—and starts the exam, because the exam is true no matter who’s right.
Then Mateo cuts the jacket sleeve away, and the forearm comes free, and there’s the tattoo.
Fine black lines on the inner left forearm. A small sun, eight rays, the third ray sitting slightly crooked because the artist was twenty-two and so was she. Half the department has seen this tattoo—Santos wears short sleeves like everybody else and runs a rotating stock of deflections when the interns ask (it’s a burn scar, it’s gang-related, wouldn’t you like to know, Huckleberry)—and nobody knows what it is. Yolanda knows what it is. Yolanda was told what it is at 2 a.m., in the dark, in the voice Santos uses for maybe four sentences a year, and traced the crooked ray while she listened.
It’s Santos.
For one held beat, her hands stop. The bay keeps moving around them—Dana talking, Abbot’s suction, the monitor marking time at 132—and Yolanda stands with her palms on Trinity Santos’s abdomen. She knows the weight of this body against hers in sleep. Under her hands, the belly keeps distending.
“Belly’s full of blood,” she says, and her voice comes out level, the voice she trains juniors to use. “Ultrasound. Now.”
The probe confirms what her hands already know. Right upper quadrant: a black stripe where no black stripe belongs. Left upper quadrant: worse, free fluid around the spleen. “FAST’s positive. Activate the massive transfusion protocol, O-neg on the rapid infuser.”
“First unit’s up,” the nurse on the infuser says.
“Keep it coming. I want six ready before we roll.” Yolanda doesn’t look away from the belly. “Pressure?”
“78.”
“Type-specific the second the cross comes back.” She glances toward the desk. “Abbot.”
“Already on it.” He’s got the OR line pinned between shoulder and ear, gloved hands still working the airway. “Three, we need her in ten, not fifteen. Trauma surgery’s operating.” A pause, listening. “Yes. Her.” He doesn’t look at Yolanda when he says it. She adds that to everything else she isn’t examining right now.
On the gurney, Santos surfaces.
It happens the way it’s been happening the whole ride, apparently—the eyes opening unfocused, the body arriving before the mind—except this time she fights. Fights the mask, fights the collar, one hand coming up off the gurney fast even now, gymnast-fast, and Dana catches it and holds on.
“Hey, hey, hey. You’re okay, honey. You’re at work—you made it to work, how’s that for dedication.” Dana’s voice is thirty years of this, warm and unbudging. “Trinity. Stay with us.”
“You’re at the Pitt, Santos.” McKay leans into her eyeline, steady, unimpressed by the blood the way only McKay can be. “You got hit by the worst commute in Pittsburgh history. We’ve got you. You hear me? We’ve got you.”
“She’s tachy to the 140s,” McKay says, catching the change on the monitor. “Sats holding at 93 on the mask.”
“Second unit’s in,” Mateo says. “Line’s good.”
“Keep the pressure running,” Yolanda says. “I want to be in that room in five.”
Santos’s eyes track—Dana, McKay, the ceiling—and land on Yolanda. Focus, for a second. Something crosses her face under the mask, under the blood, and there is no time to read it and no version of Yolanda that wouldn’t try. Her mouth moves. No sound behind the mask, or none that survives the bay, and then her eyes roll, and she’s under again, and the monitor’s count climbs three beats.
Say something. Dana found six sentences. McKay found five. The words exist—you’re okay, stay with me, I’ve got you—Yolanda can hear their shape, and she opens her mouth, and what she finds there instead is inventory. Pressure 80. Two lines in. Belly full of blood. Spleen versus liver versus both. Minutes of reserve, single digits. It’s the only language that’s ever been safe between them, and it turns out it’s the only one she has: she cannot say stay with me to this woman, in front of these people, because it wouldn’t come out sized for a colleague. Santos had looked straight at her. She had waited. Yolanda says nothing to her at all. She lets Dana hold the hand.
She’s known this woman’s body for ten months—knows it asleep, knows it laughing, knows the sound it makes when it lets its guard down at 2 a.m.—and the next thing she knows of it will be from the inside, cold room, blue drapes, ten hands. That’s the whole situation. She flattens it into one line and looks up.
“She needs a laparotomy now,” Yolanda says. “Get me an OR.”
“Three’s holding,” Dana says. “Which surgeon?”
The room is all motion—blood going up on the pole, Mateo taping the second line, Abbot watching her over the mask with those level 3 a.m. eyes, and under Yolanda’s hands, at a pressure of 80 and falling, Trinity Santos.
“Me,” she says.