Chapter Text
Like clockwork Jack found himself on the roof again. A light breeze softly ran through his salt and pepper waves as he gazed out at the city around him. He took a long drag off his cigarette– an unfortunate habit courtesy of his time overseas. But it was better than jumping, or at least that's what he tells himself. It was only 7 in the morning but Pittsburgh was awake and buzzing already; the wails of sirens mingled with the smell of exhaust. Jack sighed as he tried to rub the tiredness out of his bloodshot eyes.
“Thought I might find you up here” Jack doesn’t need to turn around to know it’s Robby.
“Don’t worry about me,” Jack said with a rasp in his voice.
“Oh come on now what sort of friend would I be if I didn’t worry,” Robby exhaled and looked up as his hands dug deeper into his scrub pockets. “You sure about working tonight? Shen offered to cover–” Jack shook his head.
“No, no, seriously I’m fine,” He glanced over at Robby, squinting in the morning sun. “That’s enough daylight for me,” Jack said as he climbed over the railing.
“You sure left a nice mess for me down there,” Robby chuckled as he ran his hand through his silver streaked beard.
“It’s the gift that keeps on giving,” Jack smirked. He flicked the last of the ash off his cigarette and tossed it on the ashtray on top of the trash can. He walked over to Robby and put his arm around him as they made their way back down into the Pitt.
***
It was nearly 8:30 by the time Jack finished handing things over to Robby, and he still had a mountain of shit to chart. It would have to wait. He logged out of the computer and grabbed his camo backpack from his locker. He only lived about a 15 minute walk from the hospital, but after tonight 15 minutes seemed like an eternity. He sighed again and took a sip of whatever was left of last night’s coffee from his black yeti. It was unsurprisingly lukewarm and watery.
As much as he joked around about loving the darkness, he couldn’t help but smile a bit, feeling the warmth on his skin and the breeze in his hair as he walked home. It was the kind of breezy summer morning that told you the day would soon be unbearably hot. Fuck. Jack hoped he would be fast asleep in his air conditioned house by then.
His leg ached and throbbed under him as he crossed the threshold of his house. He let his backpack fall on the bench by the door as he sat down, his head in his hands. He had to practically drag himself to the bathroom. He let the water run for a couple of minutes as he peeled off his sweaty scrubs and took off his prosthesis. He hopped into the shower and sat down on the stool he kept in there—closed his eyes as he let the cool water cascade around him–washing off the dirt and grime from the shift.
By the time he was finished he felt more awake and calm, but his body ached for sleep. He pulled on a ratty old army t-shirt and collapsed into bed.
***
Jack didn’t often dream anymore, which by all accounts was probably for the best. When he did though, he was greeted by flashes of patients he couldn’t save; their faces blurred together but their cries were shrill and piercing. But today he found himself back in the desert. The harsh sand blew with a vengeance in the hot wind, and a cacophony of explosions in the near distance permeated the heavy air.
He woke suddenly, drenched in his own sweat. The air conditioner unit purred from the window comfortingly. His sheets were stuck to his body in a mess of sweat and he struggled to untangle himself from their grip. Fuck this shouldn’t be affecting him like this. He blinked quickly as he heard another BOOM in the distance. He took a deep breath. It’s just some stupid fucking kids. He gripped his phone tightly in his hand and gazed down at the screen. July 4th, 1453. Well he got more sleep than he thought, although to say it was restful sleep would be hyperbolic.
He sat up in bed and ran his fingers through his hair. His leg ached dully as he reached to massage it. He grabbed the glass of water sitting on his bedside table and took a long sip. Tonight was always a fun shift to work. Fun in a hellish adrenaline filled type 2 fun way. Which was usually just Jack’s cup of tea. His attention shifted back to his leg, or what remained of it– Nope, stop, we’re not going there. Another handful of fireworks went off just then with perfect comedic timing. He shook his head and rolled his eyes.
***
Even as the evening approached, the sun gave no signs of setting any time soon. It glared down with a blazing defiance. The morning breeze long gone as the heat laid siege to the city. Jack pulled on a pair of clean black scrubs, faded, soft, and well worn from years of use. He reached down and pulled on his hiking shoes carefully tying the laces with his calloused hands. He grabbed his water bottle still dirty from this morning and threw it in his bag, fuck it I’ll deal with it when I get to work. He made sure he had everything he needed (and somethings he hoped he wouldn’t need) in his backpack before swinging it over his shoulder.
The walk to work went by in a blurr, before he knew it he was standing in front of the Pitt’s entrance. He took a deep breath and walked in where he was met with the all too familiar chaos of the waiting room, the smell of antiseptic, and a feeling of excited dread. Making his way past the lockers and setting his things down at the nurses station. Dana sat at her computer, glasses perched on the bridge of her nose, her face framed by flyaway hairs that escaped the grasp of her brown claw clip.
“How’s my favourite cowboy?” She smirks, pulling her glasses over her head.
“Don’t let Robby hear you calling me your favourite,” Jack bantered back at her. She grinned and shook her head, her eyes sparkling.
“Robby’s worried about you kid,” Dana crossed her arms as she walked over to Jack.
“I’m a tough cowboy,” Jack said sarcastically and smirked. Dana gave him a look but said no more.
“Are you guys talking about me?” Robby laughed, “All good things I hope”
“Nothing but the best” Dana cooed and winked at Jack who quickly looked down at his feet, hiding a slight smile.
“Alright brother, what mess are you leaving me with tonight?” Jack looked at Robby.
He fiddled with the black stethoscope hanging around his neck.
“Oh you know the usual shit I–” Robby was cut off as the paramedics wheeled in a gurney beside him.
“20 year old male, restrained driver in MVC, blunt force trauma to the chest, BP 87/50, heart rate 120, intubated in the field, 500 cc of normal saline in”. The younger medic hastily gave report.
“Any other passengers?” asks Robby.
“None”
“Alright,” Jack claps his hands, “Get him to uh is trauma 3 open?” Danna nodded quickly.
“Ellis, Santos, Mohan, in here, and somebody page trauma surgery”.
***
“Diminished lung sounds on the left,” Santos said a bit too excitedly.
“BP is dropping, 76/50.” Jesse stated, “Starting a second large bore, prep for MTP?”
Jack nods, he got out the ultrasound and placed the probe on the patient’s chest.
“What am I looking at Santos?” Her eyes lit up as she slid over to see the screen.
“Woah cool!” Jack gave her a look, “Oh right, um looks like tamponade? Can I do a pericardiocentesis?”
“Dr. Ellis, where are my landmarks?”
Without missing a beat, “Left costoxiphoid angle aiming towards the clavicle?”
“Great, let’s get a spinal needle, drapes, betadine, syringe, let’s go.”
Dr. Ellis inserts the needle, “Aspirating”. Bright blood fills the syringe. “10 ccs”.
“BP improving, 92/64” Jesse said with relief
“Dr. Santos, what’s your game plan?”
“Give a unit of O pos, let’s draw CBC, CMP, tox screen, let’s also get a chest xray?”
“Why the chest x ray?” Jack presses her.
“Uh um to rule out pneumothorax, because of the diminished lung sounds?”
“Great, perfect.”
“Uh so if he needs a chest tube, I can do it right?” Santos asks with a glimmer in her eye.
“Woah slow down, we’re not quite there yet.”
Jack looked over at the door as Dr. Walsh walked in. The corners of her mouth twisted into a sly smile.
“What sort of fun do we have here?”
“Restrained driver, hypotensive and tachycardic, diminished lung sounds on the left, cardiac tamponade on POCUS, BP improved after 10 ccs aspirated from the pericardium.” Dr Mohan piped up. Jack smiled.
“He seems stable for now, we’ll have an OR ready when or if he needs it. What’s his neuro status?” Walsh asked dryly.
“Pupils equal and reactive, he was intubated in the field; the medics said he was unconscious only responsive to pain on the scene.” Mohan stated. “Should we order a head CT?”
“You got it.” Jack nodded in approval as he stepped out of the trauma bay, shed his gloves, and took a deep breath. Robby was waiting around the corner for him. His hands on his hips.
“You doing good?”
“Peachy” Jack said with a dark laugh. “Go and get out of here Robby, get some sleep.”
“Oh I’ll try… my neighbors have been bragging about the massive firework show they’re putting on so I’m sure I’ll be in for a very, uh, exciting night.”
“Not too exciting, don’t want you to end up back here. It’s not very fun being blown to shit.” Jack bit his lip to stifle a laugh. “I should know.” He said with a straight face glancing down at his leg.
Robby just looked at him and scratched his head.
“Night shift humour… there’s nothing like it.” He laughed to himself as he walked off down the hall.
***
“Dr Abbot!” Mohan’s voice rose above the cloud of noise surrounding the Pitt.
“What do you have?”
“In trauma 2, we got a 5 year old boy, firecracker vs hand” She grimaces slightly.
“So it begins…” Jack sighed and chuckled a bit. “I’ll be right there.” He followed behind Mohan as fast as he could, his leg was already acting up. He felt a searing shock wave like lightning twisting up his ankle that no longer existed. Not now… motherfucker.
As he walked into the bay he saw who he assumed to be the child’s mother. She was appropriately distraught, her hands clutching the unaffected hand, muttering something under her breath.
“Ma’am, does your son have any allergies, does he take any medications?”
She looked up at him, her eyes clouded over in a daze. “Uh.. no no medications, just tylenol sometimes…is he going to be ok? God–”
“Does he have any allergies?” Mohan asked again. The mother shook her head, cupping her mouth with her hands.
“I– He was just outside for a couple minutes. I swear–How did this happen…”
“What matters now is getting your son the help he needs, I think it might be best if you step out, Princess, how about you show Mom to the family room.” Princess nodded and caringly took the arm of the mother.
“His name is–-it’s Owen” She stuttered out. Princess whispered some words of comfort into her ear as she guided her out of the room.
“Let’s get Dr. Walsh in here, this kid is definitely going to need the OR–”
“Is there a hand surgeon on call tonight?” Mohan interjected.
“This is their night to shine” Jack laughed darkly as he began his exam. Owen was screaming, big fat tears streaming down his small face.
“0.3 mgs per kg of morphine please, let’s be quick about it!” Jack pulled on his gloves and looked down at the boy’s hand. Jack was no stranger to explosive injuries and mutilated body parts, even on a child. But even his expression tightened as he examined the wound. The blast had essentially torn the hand into pieces. The thumb stuck out at an odd angle, probably broken, the middle and ring fingers were practically obliterated.
“Portable x-ray?” The cocky voice of Dr. Walsh broke Jack out of his momentary haze.
“On it!” Mohan wheeled the x-ray machine over.
They all glanced at the screen showing the decimated hand.
“Damn” Dr. Walsh pressed her lips together as her eyes brightened. “I’ll page Dr. Timmons the on-call hand surgeon, he’ll have a field day with this!”
***
Once the boy had gone up to surgery, Jack made his way back over to the nurses station. He glanced up at the board and saw Santos out of the corner of his eye.
“Find anything good?”
“Not really, just some broken bones, mild burns, standard alcohol poisoning…” She sighed dramatically and yawned.
“Don’t sound so disappointed Santos, the night is still young.” She rolled her eyes affectionately and walked away. Most likely on the hunt for procedures. Oh to be young. He smiled to himself. He hated to admit it but he saw himself in her in many ways. Yes she was cocky and a bit annoying at times but she had the spark. He grunted as he took a seat at the nurses station, logging into his computer.
“Abbot, can I pick your brain on a case?” Dr. Ellis slid on her stool over beside him. He rubbed his temples and turned towards her.
“What’s going on?”
“I got a lady in north-7 she’s super lethargic, nauseous, clammy, diaphoretic, tachypneic. No signs of trauma, she’s not in our system.”
“You check a sugar?”
“Motherfucker…” Dr. Ellis said clearly frustrated with herself.
“I’ll bet ya it’s through the roof–”
“New onset DKA?”
“I’d put money on it.” Jack crossed his arms.
“What’s your game plan? What are our top concerns in DKA?”
“Once we get her labs back we’ll know more, but start her on fluids–LR?”
Jack nodded, “Why’s that?”
“To avoid risks of hyperchloremia from normal saline?”. He gave an approving look.
“Okay, bolus of LR, start an insulin drip, if the insulin gets below 200 hang dextrose.”
“Don’t forget to check a potassium, if her potassium is already low when you give the insulin you risk pushing it all into the cells and making her hypokalemic” Jack added.
“Thanks Captain!” Ellis said as she gave him a slight salute as she backed away. He laughed amusingly.
***
As the night wore on, Jack found himself becoming much more tired and irritable. The lack of restful sleep during the day was coming back to bite him in the ass. He would make it through, he always did. Embrace the suck, right? Interrupting his pity party was the mother of the firecracker kid.
“Excuse me Doctor uh,” Her eyes darted down at his badge, “Dr. Abbot, is there any word on my son?” Jack looked up,
“I haven’t heard anything, but I’ll go check for you.” She gave him a halfhearted smile.
The truth was, Jack knew the kid was in for a rough time. Blast injuries are unpredictable and rarely allow for a clean fix. He gritted his teeth as he felt another jolt of static burst through his leg. It felt like he was walking on hot coals with icy spikes on them all while lightning twisted around his leg. He hadn’t had it this bad in a few months.
“Hey Walsh, any news on the firecracker kid?” She looked at him noticing he was in pain but made no comment, which Jack was thankful for.
“Last I heard they were still debriding, they’re trying to save as much as they can but given the extent of the injury and the damage to the underlying structures they may have no choice but to amputate”. Her voice lingered on those last words as she bit her lip.
“Thanks, the mom is pretty distraught, she asked for an update…” He sighed, deeper than he had in a while. There was a world of grief wrapped in the sigh, but there was no time to unwrap that now. He tried to think of what his therapist would say but the words all but escaped him.
***
He decided that his therapist would probably tell him to slow down, take some breaths, and get some air.
“I’m gonna take 5, I’ll be in the ambulance bay if anyone needs me.” He said as he walked out outside.
“Thought I might find you here,” Dana chuckled as she put her cigarette up to her lips.
“Needed some air, you know.” Jack shrugged. He fidgeted around in his pockets feeling for his own pack of smokes but realized he must have left it at home. Dana held out a cigarette.
“Thanks” He mumbled as he took it between his lips and lit it. The glow from the flame flickered around his face.
“One of these days I’m gonna quit,” Dana laughed to her self and shook her head, “But fuck, this place takes so much.”
“It gives a lot too, for better or worse.” Jack said after a few moments had passed.
“Does it ever” Dana flicked the ash from her cigarettes onto the pavement. She gave Jack a reassuring pat on the shoulder as she walked back in towards the ER.
“Duty calls” She flung her hands up in mocking desperation.
Jack took another drag from his cigarette, finally alone with his thoughts. BOOM. BOOM. BOOM. A triplet of fireworks roared and ripped through the night sky above him. Jack found himself breathing quickly and deeply but he still felt starved for air. His fingers went limp and the cigarette fell from his hand. Fuck. No. I’m okay. Not now. Fuck. His mind raced, a cloudy blur of images and sounds surrounded him. The feeling of hot sand in his boot, sticky blood in his hair–still warm, the sounds of explosions tearing through flesh–his flesh, everything was hot and then nothing. His heart galloped in his chest, he tried to breath but BOOM BOOM BOOM. He heard cheers in the background. He shook his head. I’m fine. I’m safe. Really this is stupid. Fuck. I”M FINE. As if shouting to his brain would turn it off. He let out a pathetic guttural noise–something in between a cry of despair and a grunt of pain. It was probably a bit of both.
He fished his phone out of his scrub pockets and his eyes darted across the screen, fixated on the notification.
Robby: Hey man, I just wanted to check in. I’m off tomorrow so if you need anything I’m here.
Sent 2034
He wanted nothing more than to be with Robby right now, but he turned off his phone, placed it in his pocket, and walked slowly back into the Pitt. The moonlight cast a gentle haze down into the night, but the lights from the city obscured even the brightest of stars. A flurry of bright fireworks exploded across the sky above him as he walked in the door.
***
The loud chaos of the Pitt was a welcome change from the turbulent quiet of Jack’s mind. As much as he wishes he could go home and sleep, he knew it was best that he was here.
“Hey uh Ja- Dr.Abbot,” Samira approached him nervously, “I have a pregnant woman in south-10, nauseous and vomiting, now resolved after 0.4 mg of Zofran and I have a litre of LR running now.”
Jack nodded and gave her a thumbs up. “Seems like you got it figured out” He smirked.
“How are her labs?”
“Um good, yeah she’s stable. Her sodium and potassium were a bit low, but understandable with the vomiting. The fluids should help but we’ll continue to monitor.” She gave him a smile that didn’t quite creep high enough to reach her eyes.
“Are you doing alright Dr. Mohan?”
“Oh yeah, I’m great, tired.. You know. But no– I’m good.”
“Good,” He smiled at her. “Good.” He muttered, mostly talking to himself.