Chapter Text
The emergency department at night is usually a quiet affair punctuated with the odd drunk who’d taken a swing then missed, kitchen mishap or stomach bug that had parents panicking.
But tonight? Chaos.
Both trauma bays are lit up—two teenagers, one wrecked car, two very different cases. Bay One has parents. Consent. Textbook infusion and stitches.
Bay Two? No ID. No one can start on trying to reach the kid’s parents. No one can get his vitals steady. And Bay One’s parents? Already threatening legal action.
Someone had paged you in. You were on call, covering someone on vacation. You don’t know who called you. It doesn’t matter.
You’d just left the parents in Bay One, placated with your promise to keep them updated—translation: please don’t escalate this while I figure out what the fuck is happening. You’d told Bridget, one of the nurses, to page the night-shift social worker. Those parents needed support more than a lawyer.
Now: Bay Two.
You pushed through the doors into heat and noise.
Male. Mid-teens. No wallet. Baggy clothes soaked in blood, shirt slashed open down the middle. Pressure dressings already saturating on his right side. There’s a shoe on the floor—might be his. One wrist wrapped. The other, an IV line and a trail of blood running toward his elbow.
Jack and Emery—senior attending and trauma surgeon—stand on either side of the gurney, already mid-argument.
“Vitals tanking,” someone calls. “BP eighty over—”
“Cuff’s wrong,” Jack snaps. “Try again.”
“Doesn’t matter,” Emery says, cool and clipped. “Pressure’s still dropping.”
“Then we need to get him up to the OR.”
“Not a chance. He’ll crash in the elevator.”
Jack’s expression is locked in that hyper-focused calm he wears when the room starts spinning—like he’s already three steps ahead of everyone else in the room and can’t afford the luxury of expressing how bad things could get.
Emery, on your right, has her arms crossed tight against her chest, jaw set, gloved hands clenched.
You’re at the foot of the bed. No one’s noticed. Or they’re pretending they haven’t.
The monitor’s still dropping.
This was the legal nightmare that dragged you out of bed at 2 AM.
Technically, the hospital can initiate emergency care under implied consent. But implied won’t save anyone in court if a lawsuit follows. Bay One’s already a legal threat. Bay Two could become the bigger one—fast.
And you’re already regretting throwing your name back in the on-call pool.
Even if everyone involved agreed the kid needed care, the decision to perform surgery without documented consent on a minor. That’s a call you, Legal, have to bless.
Jack rolls his eyes, “You can admit him, Walsh, you’ve admitted worse before.”
“He’s actively hemorrhaging.”
“He needs an OR before he crashes,” Jack’s eyes lock with hers, “he’ll bleed out in the bay. I can get him stabilized for transport, we’ll pack him and run. I can keep him alive.”
Emery scoffed, “You want to gamble on a gurney ride with a kid whose pressure’s circling the drain? That’s not treatment—that’s a coin toss, and you know it, Jack.”
“It’s better odds than cracking him open here.” Jack bites back.
If they open him in the ED and lose him? It’s on them.
If they move him and he crashes mid-transfer? Same.
Jack’s betting on movement. Emery’s betting on control.
Emery sucks on her teeth. She doesn’t speak. She looks at the kid again—pale, smaller now. Her jaw works like she’s chewing on the outcome.
“Then what if he arrests in the elevator?” she asked coldly.
“Then we crack him on the gurney. We’ve done worse.”
“We?” she echoes. “You really want to play cowboy here?”
She’s not wrong. That’s what pisses Jack off the most.
The kid is crashing in real time now. It’s not a guess when Emery says he won’t make the elevator. She wants to open him up here and control the bleed before cardiac arrest.
Jack leans in, forces Emery to meet his eye, “We did this all the time at the combat support hospitals, you know that. He’s got a window—we move now.”
Emery doesn’t flinch and holds his gaze.
“Fucks sake, that is your answer for everything—we’re not stitching bodies in the desert.”
“Don’t do this,” he warns.
“No. Let’s do.” Her laugh is bitter. “Let’s unpack your battlefield logic and how it applies to this underfunded, short-staffed civilian hospital.”
You’d seen them argue plenty of times—who hadn’t?—But this is different. Sharper. Slower. More personal.
And it wasn’t the first time.
You’ve seen it building. In the length of their silences. In how they double-check each other’s work.
“Hey—hey. Stop!” You raise your voice.
Nothing. Not a flinch.
They don’t stop.
“You know what I think?” Emery says, voice rising. “I think you’re just set on playing G.I Joe in your head and you’re going to kill this kid because you can’t handle not intervening with some MacGyver shit.”
Jack’s voice goes cold. “And you’d rather stand still and watch him bleed out?”
“I’d rather not operate on a patient who isn’t stable enough to make it up a floor.”
“Then help me stabilize him.”
“I have been!”
You’re still stood at the foot of the bed.
And that’s when the monitor spikes—the alarms scream, and the boy on the table is convulsing, chest seizing beneath blood-soaked bandages.
“Pressure’s dropping again,” a nurse yells.
Jack and Emery move—reflex, muscle memory. Yelling orders off of one another.
And then—as if in sync—they turn and look at you.
“Tell her I’m right,” Jack barks.
“Tell him I’m right,” Emery counters.
You glare at both of them. One well-oiled, dysfunctional machine.
You square your shoulders.
“Minor. No guardian. No documentation. We have a trauma-certified ED and two staff members burning what time they have left on a pissing contest that should have been over,” you check your watch, “five minutes ago.”
You take in the teen, suddenly looking a lot younger than he had just a moment ago. Pale. Still bleeding. One rib sitting a little too high. Bruises blooming purple across his abdomen.
“I don’t give a shit whose turn it is to be right. One of you needs to make the call. Or better yet, agree on one. If you’re asking whether you can treat him—yes—legal clearance is not an issue.”
In the absence of identifiable family or known medical history, Pennsylvania law allows treatment under implied consent if the procedure is deemed immediately necessary to preserve life or prevent permanent harm.
You turned to Jack first, “You move him upstairs, you need to be sure he survives the trip. Because you’ve wasted enough time, you don’t have any if he codes in the elevator. That’s on you.”
Then to Emery. “Crack him open here and lose him because we weren’t ready? That’s on you.”
They don’t speak—but they keep working.
You step back. A nurse rushes past.
“Make the call, because what you’re doing now? You’re just arguing with the clock.”
A long beat of silence followed.
Then you saw it. An unspoken look passed between them. One that said more than either one of them was ready to admit.
Then—
“Fuck it,” Emery says throwing up her hands. “Pack him and get the OR on the phone and tell them to be ready the second those elevator doors open.”
They don’t speak after that. Emery packs the gauze. Jack pushes meds.
You’re already gone.
You grab your jacket from the back of a chair at the hub and head for the ambulance bay.
Five minutes. That’s all you need.
Before loose ends. Before reports. Before home.