Chapter Text
The pills rattle as they fall onto the wooden tabletop. Small round tablets stand out starkly, especially in the darkness of his bedroom. The sun hasn’t risen yet, one of the things he always disliked about winter, and he fights the urge to go back to sleep. How nice would that be, just plummeting back into the warmth of his blanket and not having to worry about saving patients and teaching med students…and taking his pills.
Dennis lets out a deep sigh and picks up one of the tablets before gulping it down with a mouthful of water, and continues to get dressed. He pulls a face when the taste lingers on his tongue. There are certainly better experiences, but this has been part of his routine for so long that he no longer really cares. He collects the few remaining pills and puts them back into the case. A normal white bottle, like the ones he uses every day at work, with Metoprolol tablets printed on the label. He kind of misses the ones he had before, the succinate ones; they had fewer side effects, longer half-life, and fewer contraindications, but they were also more expensive, and there is no way in hell he’s able to pay $80 upwards a month on fancy name brands.
“C’mon, Huckleberry!” Trinity knocks violently on the door, and he nearly drops the whole bottle. “I need to catch up on my charts and can’t wait for you today.”
“Shit…” he mutters when he catches a look at himself in the small mirror. His hair is still unkempt, and the bags under his eyes look worse than the day before. “Coming!” he shouts and grabs his backpack.
Trinity is already at the door and waves her hand in the air in an effort to get him to move faster. He tries his best to match her speed, pulling on his beat-up Nikes, which used to belong to every single one of his brothers, and grabbing his coat, which gets stuck on the doorknob.
“Jesus, how did you even survive on your own?” he hears his roommate mutter under her breath as she’s finally able to lock the door behind them.
He is about to open his mouth, not even sure what he is going to say, it’s not like she’s wrong after all, but is interrupted by a hand pulling him along the hallway of their apartment complex. His feet nearly get tangled as he is being dragged along.
“We talked about this yesterday, man. I need to get there early; otherwise, none of the parking spots at the lower levels are free.” Trinity pulls free another pair of keys, this time the ones for her old Honda. “I swear to God, all these people are lazy. Why the fuck are there even that many cars? I mean, hello? What about the environment?”
“But aren’t we also driving there?” Dennis wonders, and his arm is finally released from his friend’s grip.
“Yeah, but we carpool, that’s different from the sixty-year-old cardiology or dermatology chiefs, who need to use two spaces for their big-ass BMWs.” She pushes open the door to the small car park, and the familiar `beep´ of her Honda echoes through the cold air.
They do end up in traffic on the way; there seems to have been an accident on one of the main roads, and while Dennis mentally prepares himself to witness Trinity’s very colourful vocabulary, whilst stuck in the small traffic jam, he finds that he doesn’t need to. Apparently, the fascination and excitement of an MVC override her annoyance, and instead she spends their time in the car talking about the possible injuries of the person. Dennis finds it a bit macabre, but throws in a few theories as well.
In the end, they do have to take a spot on the third level, not bad, but also not down between the attendings BMWs. The rush doesn’t stop there, though; as soon as the car is locked, Trinity nearly sprints to the entrance, her bag making metallic clanking sounds as the thermos bumps around inside.
She calls out for him to follow her, but he brushes her off and tells her to just go ahead; they’ll see each other in the ER anyway. Running through their workplace to get to a patient is one thing, but running through an entire hospital is definitely not on his agenda for today—or any day for that matter.
As he walks through the corridors alone, he can’t help but search for his pulse on his wrist. His fingers find the radial artery immediately, used to the sensation after having to check his heartbeat for so many years. A smartwatch might be a good investment, but that’ll have to wait until his wallet has more inside than just dust and a button, which he always mistakes for a quarter.
The hallways are familiar now, one blurring into the next. Patients slowly awake, the nurses change shifts, and alarms start ringing behind the heavy glass doors. Finding the ER is easy if you know what you’re looking for. The sounds coming from there aren’t muffled, the voices aren’t whispered. The people working there couldn’t care less about being silent, especially not with human lives on the line, and this is all the more pronounced by the strong smell of disinfectant, which barely covers the metallic scent of blood underneath.
He rounds another corner, passing radiology, and the previous thought about the ER not being silent is confirmed by the noises that greet him. People moan, gurneys squeak, and fellow doctors and nurses talk loudly, hoping their voices carry over the usual chaos that surrounds them. He passes the lockers first and quickly stuffs his backpack and coat away, then pulls out his badge, his ECG crib sheets, which he wants to show Joy and Ogilvie, some pens, and his phone.
One look at his watch, and he curses at himself for not walking a tad faster before. The door to the central area of the Pitt opens, and he is almost immediately run over by a patient in a wheelchair. He can barely move out of the way when a hand lands on his shoulder from behind. “Nice of you to join us, Dr Whitaker.” A gruff voice says.
“I’m so sorry, sir. Trin—I mean Dr. Santos and I were stuck in traffic.” He apologises when Dr Robby steps in front of him, one of the white trauma gowns already halfway up his arms.
“But she was here on time.” The man says and walks away, while motioning Dennis to follow. “We have two people coming, MVC. Dr Langdon takes the more critical one, you and me, the other patient. You do the primary survey, and go get your ducklings; this is a teaching hospital after all.”
Dennis grabs a gown for himself from the wall dispenser and falls into step beside Robby for a few paces before breaking off toward the nurses’ station. He spots his students almost immediately—Joy and Ogilvie lingering near Javadi, watching the board like it might start talking back. He squares his shoulders, already shifting into teaching mode.
“Hey, you guys ready? Dr Robby wants us to perform the primary survey on an MVC victim who will be arriving soon.” He says while tying the gown behind his back.
“Of course,” Ogilvie is first to respond, as always, “Any more information?” The student is always eager to work and show his knowledge, which kind of reminds him of Trinity, but in a bad way. It’s not that he dislikes the other man, it’s just that he’s kind of jarring, always flexing and occasionally correcting him on technicalities in front of Robby. The fact that his neck slowly starts to hurt from the continuous strain of looking up doesn’t make it better.
“Ehm, no, but I don’t assume it’s going to be that bad, otherwise Dr Robby would’ve called for more people.” He responds, and they make their way back to the attending, just in time for the doors to burst open.
The man on the stretcher is propped up and holds an oxygen mask to his face, a good sign, when the EMTs wheel him in. “Jared Finnings, 34, got rear-ended at a red light, slight neck pain, neuro exam was normal, no obvious injuries apart from a laceration on his head and possible broken ribs.”
Dennis moves along, mentally charting every piece of information that might be important. “Mr Finnings, my name is Dr Whitaker, this is my attending, Dr Robby and two of our med students. Do you remember what happened?”
“I—I was just at a red light and then someone crashed into me.” The man all but cries from behind the mask.
“I understand. Was the airbag of your car activated, or did you hit the steering wheel?”
Mr Finnings chokes on what Dennis takes to be a laugh. “If my shitty car had airbags, I wouldn’t be in this fucking situation.” The man rasps and winces afterwards, curling into himself slightly as they move into trauma room two.
Dennis moves around the room quickly and efficiently, first checking the head wound, after making sure the man’s vitals are stable. The gauze peels away with a wet squelch, and the blood anchoring it to the skin has clotted. It’s another good sign, at least the bleeding has stopped for now, and he can concentrate on the examination. “Scalp laceration approximately ten centimetres wide, superficial, bleeding stopped spontaneously. Simple sutures should suffice, but we’ll need a head CT to rule out intracranial injury.” He says loudly to no one in particular, but looks over his shoulder to Dr Robby to make sure he is doing alright so far.
“Which assessment scheme would we use in a case like this to continue with the examination?” Dennis asks the two students, who are standing on the other side of the patient.
“In most trauma centres, the ABCDE scheme is the standardised version for primary surveys: Airway, Breathing, Circulation, Disability, and Exposure.” Ogilvie answers almost immediately, the corners of his mouth curling upwards.
“That is correct,” Dennis moves back so roll a sono machine next to the patient, “but keep in mind that for trauma patients, we use xABCDE, as recommended by PHTLS — catastrophic haemorrhage comes first.”
He swears he can hear Ogilvie click his tongue at the small correction, but ignores it for now. “But you’ve already checked the headwound, so mentioning bleeding seemed kind of redundant.”
Dennis, still a bit unsure with his new position as a teacher, looks over to Robby again, who just raises his eyebrows at him. “Well, Dr Whitaker, why do we still need to rule out bleeding?”
“Because even if the accident seems harmless, there can be internal injuries. We need to check the abdomen, especially the rectovesical or Douglass space. We already suspect broken ribs from the contact with the steering wheel, and the pleural cavity is another spot for blood to pool.” Whilst talking, he has started to prep the sono and is about to check the man’s abdomen. “Mr Finnings, it’s gonna get cold and wet now. I just need to check for internal bleeding.”
He moves the transducer around while talking to his colleagues. “Pericardial view is clear. No free fluid in the hepatorenal or splenorenal recesses, pelvis negative — but there’s a small amount of fluid in the pleural space.” He finishes the FAST exam and moves on to check Mr Finnings airways for any obstruction, and listens to his breathing. “Do you have trouble breathing, or is it the pain from your ribs?”
“Just the pain, I think, like when I breathe in, it really hurts on that side.”
“Shouldn’t we put in a chest tube? Can I do it?” Ogilvie asks, and again, he can’t help but notice some similarities with his roommate.
“Dr Whitaker?” comes the gruff voice from behind him, encouraging him to answer the student’s question.
“Not right now. The patient is hemodynamically stable, has no significant dyspnea, and the hemothorax is minimal. He’s not anticoagulated, so close monitoring and repeat imaging are appropriate.” He finishes the rest of the exam quickly.
“We’ll order the head CT and a chest X-ray and continue monitoring the vitals.” Dr Robby finishes for him and is already removing his gown. “Our student doctors will get your history and everything else. Let us know if you start having trouble breathing, Mr Finnings. Whitaker, you’re with me.”
Dennis looks after his mentor as he leaves the room. “Alright, you know what to do. I’ll put the orders in—if he stays stable, move him to another room, in case we need this one.” He then faces his patient. “Mr Finnings, I’ll leave you in the capable hands of our students and come back later when we have the results of the imaging.” He takes off his gloves and follows Robby into the hall.
The older man seems to have waited for him just outside, and he nearly runs into him. “That was good, Whitaker. Are there some things you could’ve done differently, though?” Robby asks while starting to walk towards the nurses’ station.
“Uhm, I guess I could’ve done the assessment better, quicker maybe?” He’s still not entirely comfortable making decisions on his own; there are probably a hundred things he could’ve done better.
“Nah, that was good. Like I said, you did well overall,” Robby leans against the desk and grabs one of the tablets to put the order for the images in, “but this is an ER, you’re not alone with trauma patients. You had two med students and me, and while this case was quite tame, I would’ve liked you to spread out the work a bit.”
He takes the tablet from the man’s larger hands, ready to enter his code; it is his patient, after all, when he starts feeling it. An unspecific sense of unwellness spreads through his body.
His hands shake as they hover over the keyboard on the touchscreen, and the edges of his vision blur.
It must’ve been more noticeable than he thought, because he can feel a hand on his shoulder, warm skin brushing against his suddenly too hot nape.
“I’m not saying this to reprimand you, kid. You’re doing great, I know—Whitaker?”
He wants to answer, but the sound that comes out of his throat does nothing to help his situation. The feeling gets worse, especially around his heart. Blood rushes through his ears, loud and too fast, drowning out the room.
The tablet slips from his hands, and he distantly hopes that it’s not broken. One of his free hands clutches his chest, the fabric of his scrubs rough and foreign under his fingers. “…need to…sit down.” He mumbles, but doesn’t even hear his own voice anymore. He is about to take a step back, but his knees buckle under him, and the room tilts sharply to one side. The fall is cushioned by the person next to him, and he can feel himself being lowered to the ground.
The next thing he feels is the sudden overwhelming pressure blooming within his chest.
It burns its way through him—fast, total, unbearable. His whole body seizes for just a moment, and a scream rips itself free from his lungs.
Adrenalin fills his veins, and he slowly comes back to his own body. The floor is cold underneath his legs, the body that holds him upright is hot.
His hands are on the floor, shaking desperately against the linoleum, but he can’t make them stop, can’t even concentrate on anything else but the lingering pain in his chest.
Two sets—no, more than that—of hands pull him upright, voices overlapping without meaning.
His vision swims once more—then there is nothing.
He liked playing soccer when he was a kid. His brothers were always bigger than him and preferred football. Dennis tried that as well, but playing offence wore him out way too quickly and being the kicker was kind of boring. So he switched to soccer and turned out to be quite good in defence. Only running when he needed to and making sure the ball stayed as far away from their goal as possible.
Even his parents seemed kind of proud for once, especially after his school team made it to the state championship in Lincoln. He remembers the excitement he felt when he ran across the field and saw his family on the bleachers.
That was the last day he played soccer, or any real sport. His team was winning, the crowd's cheers filled the crisp air, and there were only 10 minutes left. The team they were playing against had the ball, and he was already sprinting towards them when his legs gave out, and he suddenly pitched forward onto the ground. The grass was damp and cold against his cheek; other kids laughed, mocking him for what they thought was a bad dive; the referee’s whistle shrieked in his ears, but he couldn’t even wince.
His memory is blank after that, and he only knows what his parents and doctors told him afterwards. It took a moment for the referee to realise that something was seriously wrong. Medics were called over and started CPR right there on the field, in front of everyone else. He was brought to the hospital, and they resuscitated him. He was only eleven, and his heart had stopped beating.
The doctors put something inside his chest that would help his heart when it felt overwhelmed, an ICD. He had to take chalky medicine, stop playing soccer and spend every free moment praying with his Mama for his health.
As a kid, he didn’t understand most of it—didn’t understand what a heart condition was, let alone what ARVC meant.
It was only years later, when he was already in med school and sitting in the library studying for an upcoming internal medicine exam, that he learned more about the topic. ARVC, or arrhythmogenic right ventricular cardiomyopathy is a genetic heart condition that leads to the degeneration of his heart’s muscle cells, the cardiomyocytes, and leaves scars of connective and adipose tissue behind. Arrhythmias and sudden cardiac death weren’t just some words in his textbooks; they were part of him, just like the ICD’s shocks that always came when he least expected them.
That became his life: beta blockers every day, episodes of ventricular tachycardia shocked back into sinus rhythm, and frequent visits to cardiology. All of that changed during his third year of med school, when he lost his financial aid and health insurance.
He didn’t want to drop out of school, but his meagre student job didn’t pay enough to keep him going to his appointments. Then came his pills; he normally got some name-brand metoprolol succinate, but they were expensive, so he switched to first tartrate, then generics, and eventually began rationing them to make the prescriptions last twice as long. It wasn’t ideal, and his heart told him so. The shocks became more frequent, from once or twice a year to multiple times a month.
Residency wasn’t much better; the hospital’s health insurance doesn’t cover new interns for up to a year, and they were buried under an administrative backlog and understaffing. Money was also still tight. A large part of his paychecks would go toward paying off his student loans and his family's inherited debt. He hasn’t seen a cardiologist in years—a mistake he is painfully aware of.
Pressure around him wakes him up. He can feel it pressing against his chest, head and limbs—tries to pull away from it with little success. Voices and sounds overlap; at first, it’s like his head is underwater, but then it becomes clearer. Beeping and shuffling, people saying his name, sharp and insistent.
“Dennis. C’mon, open your eyes.” A deep voice says, and he feels an internal need to comply. His eyelids feel heavy, as if they’re glued shut. He blinks against the lights, screwing his eyes shut and trying again with a groan.
The first thing that comes to his mind is commotion. Coworkers move around him in a blur of colours. He can see Dr Robby next to him, Jesse and Dana, and Trinity—where did she come from? His hands grip the edge of the gurney he’s on, and he tries to push himself up, but is stopped by those warm hands holding him down. “Don’t move yet.”
He starts to wake up more, like getting out of bed in the morning, thoughts only lining up after you’ve brushed your teeth.
“Wha happnd?” he mumbles, and his brows furrow.
“You passed out.” Is all Robby says to him before turning around and calling out to Dana. “Get him in line for a CT and—”
He is stopped by Dennis, who reaches out and grabs the sleeve of his forest-green fleece. “No CT. I’m fine, I just need a moment.”
“You passed out in my ER and had a spasm. I’m not taking any chances.” He is about to turn away again, but Dennis still holds onto him tightly.
“It’s just… migraines, maybe with aura, I don’t know, but it’s fine.” He looks around the room and finds Trinity. She has the same concerned look on her face as everyone else in the room, and it makes him feel sick. “I…could you get my bag, please? I have some meds in there.”
Trinity doesn’t move at first; she looks over to their attendant as if asking for permission. Robby lets out a sigh at the same time as Whitaker lets go of his jacket. “Go,” he waves her off and then ushers the rest of the staff out of the room.
The silence that follows lasts only a few seconds. Robby snaps on a new pair of gloves when Dennis notices the IV kit on the table next to him.
“Hey—no,” he argues again and finally sits up without someone pushing him back down. “I don’t need an IV.”
The older man does not seem impressed at that, only lifting one brow. “As I said, you passed out.”
“I know.” Dennis swallows around the lump in his throat. “I’ll just drink lots of water. I promise.”
Before Robby can respond, the door opens again, and Trinity steps back inside, his backpack slung over one shoulder. She closes the door behind her, then rummages through the bag and fishes out a small, scuffed pill bottle, the label faded from too much handling.
She can’t help but inspect the bottle and frowns. “Since when do you take beta blockers, Huckleberry?”
His stomach drops. “A few years, I think?” he says quickly. “They help with the migraines.”
He puts out his hands, but Trinity deposits the bottle into Robby’s instead. What a traitor. The man puts on his glasses and turns the bottle over, clearly trying to make out the words that aren’t faded beyond recognition. The date is old, too old. He lets out another sigh and runs a hand over his face. “You need a new prescription,” He says eventually. “And preferably not generics.”
Dennis shakes his head. “The other ones are at least twenty bucks more a month. I don’t have that kind of money at the moment.”
For a moment, Robby doesn’t say anything. Then he lets out his third sigh in a short amount of time, a tired one. “I’ll get someone to bring you water, wait until you feel better and go home. Eat something and call in sick tomorrow.” He pushes the bottle towards Dennis and leaves without room for another word.
Trinity takes his place next to his bed, dropping the backpack on the floor and rolling a monitor from the corner of the room over to the gurney.
“Trin, I told you, I’m fine.”
“Yeah, the old man might believe that, but I’m your roommate, I know when shit is up.” She mumbles as she tries to untangle the electrodes, but she doesn’t plug anything in yet—just leans against the gurney, her shoulders slouching forward in a way that is uncharacteristic for her. “You don’t just pass out.” She says, followed by a somewhat deep breath in. “You trip, and sometimes you hyperventilate, but you don’t pass out, and you sure as hell don’t get migraines, at least not the kind that warrants fucking beta blockers.”
He opens his mouth, already reaching for the lie he carefully constructed over the years, but she keeps going.
“I’ve seen the scar on your chest, really bad work if you ask me, probably done by some hillbilly doctor in Nebraska.” She pauses again. “And I’ve seen the shock just now.”
His jaw tightens.
“You can either tell me what’s really going on, or I list every—and I mean every possibility until I land on the right one, and if that’s not enough, I can still hook you up to the ECG and see for myself.” She says while picking up the red electrode and dangling it in front of him as if to hypnotise the answer she is looking for out of him.
“Trin, could we not—”
“Ok, let me think. Maybe a STEMI? Prinzmetal-angina? Kounis syndrome? Or too much cocaine?” she looks at him expectantly, still holding the damn electrode, as if it’s the most threatening thing in a hospital full of scalpels and bone saws. “Congestive heart failure? No, not with your skinny ass ankles, but maybe Brugada, or Long QT, or—”
“ARVC”, he says suddenly, and his voice comes out smaller than intended. It hangs in the air for a while, as if the statement is trying to perforate every nook and cranny of the room.
“Alright…thanks for telling me.” Trinity’s voice sounds strangely calming, like when she talks to younger patients and lets down her hard façade... “Did you like…die once?”
Did he what? He whips his head around and stares at her. “What?” he has to ask, in case he misheard.
“You know what I mean. Did your heart fully stop at some point?”
He blinks away his previous confusion. Out of all the things he thought Trinity might say, this wasn’t one of them. “Yeah, once when I was eleven and again later at a college party.”
Her eyebrows shoot up at that, lips curling up slightly. “No shit.”
“Yes shit.” He responds, sporting a small smile of his own.
“That sucks, man.”
“You don’t say.”
Silence befalls them again. Then the monitor beeps, letting them know it’s about to go into battery mode. “You feeling better now? I’d still like to check out your heart, just a simple 6-lead.”
“It was just a shock. My chest hurts a bit, but as I said, I am fine. It wasn’t the first time it happened, and won’t be the last, just sucks that it happened here…you know.” He leans back on the gurney and lets Trinity attach the sticky patches for the electrodes onto his skin. “You think Dr Robby is mad at me?”
She looks up from where she threads the wires through the collar of his scrubs. “I don’t think so. Frustrated? Maybe. You weren’t really giving him anything to work with, so he couldn’t even attempt to fix you.” The monitor beeps again, ready to use now, and she presses a button to record the ECG. “He was also right next to you, I mean, he works in an ER, probably saw a lot of shit, but he seemed really…worried when you keeled over like a maiden in distress.”
“I did not—”
“Ah, no talking, please, don’t want any artefacts.” She interrupts right before ripping the sheet of paper off. Dennis sits up again, removing the electrodes himself, while Trinity looks at the ECG.
“So? What do you see, Doctor?” He asks and looks over her shoulder.
“Nothing really, kind of disappointing to be honest. Could we do a 12- lead instead?”
Dennis stifles a laugh. “Definitely not. This is fine. See no tachycardia—”
“Well, duh. Internal medicine might not be my preference, but I can still read.”
“—and there are T-inversions in lead II, III and aVF. If we had the precordial leads, we could probably see epsilon waves and an RBBB.”
Trinity only hums in response. Then she turns off the monitor and disinfects the rest, before pushing it back to the corner she got it from. “ECG’s boring. You’re boring.”
“High praise.”
“I’m being serious. I don’t know what I expected, but boring is good… boring means I don’t have to drag you upstairs to cardiology and help finance the chief’s BMW.”
A chuckle rumbles in his chest, then he exhales as his roommate sits down next to him. “Trin… I really need you to not tell anyone. At least not yet.”
She doesn’t answer immediately. Instead, she folds the paper and puts it into the chest pocket of his scrubs.
“Okay,” she says finally, “I won’t.”
Relief floods through him. Trinity has always been trustworthy with things that matter.
“But,” she adds quickly, and he tenses again, their eyes meet shortly, “You come to me when something feels off. I don’t want to have to drag your ass up from the floor again… you don’t get to scare me like that.”
He nods quickly. “Deal.”
“Good, now get up, I’ll take you home. If I’m feeling extra generous, I might talk Robby into letting you come to work tomorrow.”
Dennis jumps off the stretcher and grabs his backpack. He tries to avoid making eye contact with anyone as they make their way to the locker room. Attention has always been something he hates, especially when it is because of his condition and not him as a person. Trinity makes it better, though. She doesn’t leave his side and brushes off everyone who approaches them with unnecessary questions. She is like a steady presence he didn’t know he needed before.