Chapter Text
It begins when Samira's a senior resident. One morning she comes in a little early and finds an article taped to her locker door: "Triaging Unmet Needs: A Provisional Workflow for Activating Deeper Patient Assessment." It's about a protocol to help practitioners know when to stop and gather painstaking patient history within the perpetual motion machine that is an emergency room.
Specifically, it calls for creating a rubric to determine when it's appropriate to spend more time with a patient. It touts increased patient satisfaction scores and a less-than-expected aggregate slowdown when implementing the protocol. Some of it she agrees with — some populations need more care because they're more likely to suffer neglect — but the idea of formalizing those determinations made her skin crawl. Rigid frameworks for care can be useful, but with patients like her father, they're what has gotten them to where they are in the first place.
By the conclusion, she is more annoyed than hopeful. Then she gets to the last page, where there's a handwritten note:
This, maybe, but not the way they're doing it — Talk about it sometime?
He didn't have to sign his name. Only one person in the Pitt has handwriting that spidery, and only one person has a history of vocally fighting her about this very thing.
She re-reads the article in the pauses between patients, this time annotating points of interest, and hands it to Robby as she walks out at the end of shift.
"Coffee?" she says.
"Can't right now," he replies, evidently surprised that she's already engaging him about it. He tilts his head to the side and smiles. “Tomorrow, though?”
The next day, they end up going to a diner and eating omelets and fried potatoes while they hash out some of their philosophical differences. It turns out those differences are not that great. What they don't agree on is how to solve the problem, but they agree that someone should.
(By implicit agreement, they do not talk about the months of him calling her Slow-Mo, or, indeed, any part of their interpersonal head-butting about her speed at the job, which will always lag, comparatively. It seems like the only sane way to proceed, turning this thing into a conceptual quandary rather than emotional quicksand.)
A week later, she wakes up in the middle of the night with an idea. As in the article, it's a decision tree, to be applied at intake. But like an actual triage system, it's always tailored to a specific context and is meant to be mutable, although it's based on observable data so it can hopefully be at least somewhat unconscious bias-proofed.
She texts him a link to a Google Doc with a note: Comments welcome! By the next evening, there are at least ten comments on the document. They are…pointed. Not mean, but brutal. Her replies are equally frank. It turns out they're actually pretty productive at arguing — without nastiness, even — when the gloves are off.
He tells her he wants to work with her on this, whether it becomes an operationalized plan or just an exercise in pushing the conversation forward. He won't, however, do that until her residency is over. Put it on the backburner, he says. I promise you it will boil again later if we want it to.
She's been an attending for just shy of three months when she gets a notification that she has a new comment in the document. It's on the title, actually, and it reframes the whole enterprise in the most interesting way, like he’s maybe been mulling it over all this time.
Over the course of a few weeks, they meet in the library on the eighth floor on Wednesdays after shift to work on it for an hour or so. Fewer punches are pulled because they're often exhausted or keyed up or both, but that makes the debate more incisive. At times, when that spirited discussion (read: arguing) turns too big for the room (read: loud), they go up to the roof.
She knows they're building something real when, one night just after sunset, they're standing at the railing and discoursing sharply and excitedly — but not as an argument. They're agreeing, building on each other's ideas, picking up the threads of thought and weaving them together until it's difficult to say just which of them they came from.
(A couple of weeks later, when the document is done, they will let it breathe a while. Then they'll share it with a couple of colleagues at other hospitals, trusted physician friends who will call them on their shit if there's anything too hippy dippy or too mercenary. In the end, there will be no need for pulling back or equivocating, thankfully, although there are definitely revisions to be made. When they get it published, under the title "Toward a Responsive Workflow for Gathering In-Depth Patient History in Emergent Care," she's first author.)
That evening, they don't even hear Jack Abbot open and close the door. He's practically next to them when they realize he's there, and they don't stop immediately, not until they've come to the end of a train of thought.
When they finally turn to face Jack, he raises an eyebrow.
"The Mike and Mohan secret project is coming along, I guess?"
"Not a secret," she replies, knowing full well that he’s talked through some of it with the man from the perspective of honest-to-God triage, just like she's picked Heather Collins's brain on occasion and asked her to review their thoughts on Black and high BMI patients specifically.
Jack replies, "Yeah, but when am I gonna get to read it?"
He just looks at her and says, "Go write down what we just said before we lose it."
"I'm not gonna lose it," she replies. "But, sure, I'll get out of your no-girls-allowed tree fort."
He tilts his head like he wants to argue with her, but she cuts him off with a snort of laughter and pats his hand where it rests on the railing.
"Nice to see you, too, Dr. Mohan," Jack calls out as she walks away. He's needling her a little.
"Night, Jack," she murmurs, not taking the bait as she ducks back inside.
She realizes, in that moment, that she's a little annoyed that Jack interrupted them, and that it has nothing to do with their ideas. Those are solid now. It's just that she was…enjoying his company?
Somewhere along the way from senior resident to junior attending, she's found an equilibrium with him. It was kind of thrilling while it was happening, if a little disorienting. Now, she has a sense that she knows exactly where they stand, and it's mostly shoulder to shoulder.
She'd almost say they've developed a mutual admiration society, but that's maybe a bridge too far. She's still a little wary of his attention, still occasionally haunted by his nagging voice in the back of her head telling her she's failing to live up to the potential she has. He seems equally nervous sometimes in interactions in the ED. For a while there, he was seemingly averse to intervening with her patients when he had a contradictory idea about how to proceed, in ways that went beyond the deference that marks normal professional respect. It's an over-correction she eventually pointed out to him. The pendulum has swung a bit but now it drifts slowly over the middle ground.
He has also been mostly unable to dish out compliments, even when it's clear he's impressed by something she's done. That’s still a problem, but maybe she doesn't need to fix it. He's pretty readable now, in ways that he wasn't before. She wonders for a few weeks if that's intentional, a mark of him letting himself be known a little better to a person who is fully his colleague now, not his subordinate. But one late afternoon, one of those for which the quiet is palpable and threatening, as she's standing with him at the charge desk, she decides it can't be intentional — because he would never allow himself to be known this way at work, not after Heather, and definitely not to her.
The problem is simple: He's standing a little too close. He's hovering like he hasn't since she was early in her residency, only now it has nothing whatsoever to do with training. It is also absolutely not a sign that there's a casual ease in their interactions. He seems drawn toward her, now, like a perennial that has been in the shade too long and is finding the sun. Or maybe he's the sun and she's a tall stalk of something wild, largely oblivious of her need for the rays hitting her but soaking them up and growing stronger anyway.
(She thinks that's it: Neither of them have needed him to use words of praise when there was whatever this is flowing between them.)
She can feel the heat that always radiates from him, and she can smell his shampoo and deodorant, and she finds that she wants to lean closer. A sudden mental shift — oh, she thinks, I really would — provoked by this pull between them, almost makes her physically dizzy. Soon, she finds a reason to drift away from the desk.
Once she's put some physical distance between them in that moment, she realizes he's watching her. Rather than be unnerving, it makes her feel grounded. Maybe a little heavy, but it substitutes for contact. And she wants that. Over days and weeks, however, his occasional distanced attention, something like adoration, begins to feel light — maybe too light, like it could hover there forever, just on the periphery of their actions and interactions. Because those continue to be how they're been since the end of R4: comfortable and balanced; solid, if a little careful. Except, that is, when they take the gloves off.