Chapter Text
Pittsburgh Trauma Medical Center Emergency Department
Code of Conduct: Omega Patient Procedures and Guidelines
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If an omega is admitted without a mating mark or without an alpha present, it is required by hospital policy to ask if they have an alpha mate that should be contacted.
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If an omega has no mate or alpha partner, a designated Alpha ad Litem will be assigned unless the omega expresses written consent to be without an alpha.
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Patient History must include the last heat cycle, last rut spent with an alpha, and a pregnancy test.
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If a patient admits to using suppressants, Omega Social Services are required to be contacted.
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Physicians are prohibited from prescribing suppressants unless omega obtains permission from their alpha, mate, or primary care physician.
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Patients are not required to wear scent blockers. Physicians are.
“Get her on her side,” Dennis snapped at the med student who looked horrified. He looked at the other two without letting his concern show. “Start a timer. You need to go get one of the nurses, preferably an omega, and a resident. Attending. Whoever you can find.”
He doesn’t wait to see if the med student goes. The patient is what’s most important right now.
Third seizure from an omega patient by hour four. It’s not a coincidence. It’s sure as fuck not the first time this has happened this week either.
He’s lucky he ran out to the waiting room with at least two med students by his side. They were young, third years like Javadi. Not nearly as good though. And one fourth year who he’d prefer to stay away from.
He was lucky to snag the sub-internship spot at the Pitt before any other MS4s did. Senior staff had wasted no time putting him back to work like he had never left the chaos.
Dennis tried not to let any sounds come out of his mouth as he struggled to keep the patient still. The seizures were always violent, and it hurt him to watch the way the omegas looked so scared and fragile beneath him. He needed to keep them calm. Keep everyone around him calm.
“You’re alright,” he murmured, ignoring the stares and yells of the others in the waiting room. “Best place to do this if it makes you feel better.”
“How long?” Dr. Mohan asked, sliding down beside Dennis. Her eyes scanned the patient’s body, not touching, just assessing.
“A little over two minutes,” the med student - fuck, Dennis really needed to learn his name- replied.
“Dana’s got a bed set up whenever this is over. Someone’s bringing a gurney.” Mohan frowned, glancing over at Dennis. “How the fuck did you get out here so quickly?”
“I’m on chairs. Someone came in saying an omega was seizing.”
“Way to move. What’s her name? Does she have anyone with her? Any forms filled out?”
“I don’t know. I just got here,” he reminded her. He jerked his head in the direction of the still hovering students. “Send one of them.”
Mohan barked orders out that got the med students moving. The omega beneath them went slack, only the occasional muscle spasms in her arm. As soon as she started coughing, Dennis breathed a sigh of relief.
“Welcome back, Katie.”
“Thought you said you didn’t know,” Mohan muttered teasingly. Dennis rolled his eyes.
“Her name was the only thing I saw on the papers she was holding. I’m pretty sure she’s here alone.”
Transferring Katie to the gurney was effortless. Dennis kept moving through the motions of vitals and questions as they made their way to the open patient room. The omega didn’t have any answers to give, barely able to get oxygen into her lungs.
“Full lab work up,” Mohan decided once they had hooked her up to the heart monitor and Jesse was starting an IV. “I want a dose of lorazepam for now. Can you order the MRI and EEG?”
Dennis nodded, eyes still focused on a clearly terrified omega. “You’re good, Katie. Do you know where you are?”
He gets a hesitant, slow shake of the head. Better than nothing. “You’re the PTMC. You just had a seizure in the waiting room but we’ve got you back in a patient room now. Is there someone we can call for you?”
No response. That was fine, he’d be impressed if she could form words at this point.
“Okay. You’re going to get some meds to stop any other seizures from happening and some tests done, okay?”
He keeps talking to her throughout their poking and prodding. Her eyes followed his form throughout the room and he smiled reassuringly at her before leaving her alone with Jesse.
“Call an ad Litem,” Mohan said once the curtain was closed. Dennis made a soured face.
“Seriously? She just got here. We don’t even know if she-”
“She has no mating mark, she was here alone, and emergency contact forms were never finished. Hospital policy states we need an ad Litem in here.”
“Can’t we give her a bit of time before that? There might be a reason she was alone.”
“Hospital policy,” Mohan repeated firmly. “Come find me when they get here or when her results get back.”
Dennis sighed as Mohan kept moving. He sat down roughly at one of the open chairs, sliding his badge up to login to the computer.
He fucking hated the ad Litems. They either talked down to the omegas they were with or tried to talk over the doctors. The one that he could stomach was Kiara, and last he saw her, she was busy dealing with an elderly couple. Chances are he was getting an asshole.
Dennis spent the time waiting for the ad Litem to show up jumping between Katie and the rest of his patients. The results come back as expected; useless. They haven’t had enough patients with similar enough symptoms to narrow down exactly what these new drugs are doing to the omega’s bodies.
Katie’s patient. And sweet. Dennis tracks down her phone from where it slid underneath a row of chairs. He gets her fluids and keeps a neutral expression when Mohan talks her through the test results. The ad Litem sits in a chair beside the omega who seems to be curling away from his body. But she still can’t seem to formulate words so he stays. Even though she’s clearly uncomfortable.
Dennis doesn’t blame her. Paul’s his least favorite. The guy failed out of his graduate program and this was the closest he could get to working in a social service setting without that masters degree.
So he was an uneducated asshole, Dennis had pointed out when the other residents told him the information. Dr. Mohan’s lips had twitched and Dr. King had hidden her giggle behind a cough.
Trinity had straight up laughed.
Mohan leaves him to start working through patient history once Katie’s capable of talking. They try to remove alpha physicians from the room when the ad Litem is present. Betas or omegas are preferred.
Lucky Dennis.
He shifted his weight from foot to foot, pretending like there wasn’t a small throb at the base of his neck. “First thing’s first, would you like the ad Litem to stay or do you have a partner on the way?”
Katie spins her phone anxiously in her hands. “Oh, I already contacted my partner. They got stuck in traffic but they’re on the way.”
“Okay. Um, Patrick?”
“It’s Paul.”
He knows. “Right. Thanks for coming down on such short notice. I’ll send you any necessary followup paperwork.”
“Hospital policy states the ad Litem has to stay in the room until the patient’s mate arrives.”
“They’re on the way. Just like Katie said. We should be good from here.”
“I can’t go until the mate is here or I have written consent.”
Dennis paused, trying to control his face, but he could feel the bitchiness in his stare. “Right.”
He pulled his notepad out of his scrub pocket, and clicked his pen.
I, Katie Price, give my explicit permission for the Alpha ad Litem to be removed from my care.
“Katie,” Dennis said, avoiding looking at the alpha. “Would you sign this if I have your consent for the ad Litem to be removed from your care?”
The omega took the offered out pen and signed the paper, albeit shakily. It was still a signature. Sure it wasn’t the official form, but who would check?
Dennis tore the paper out of his notebook, holding it up and staring challengingly at the alpha.
“Go ahead. We’re good here.”
The alpha glared unimpressed before sliding out of the room.
Katie frowned. “Wow. He was kind of the worst.”
Dennis bit his lip to stop from laughing. “Is that your official request for a new ad Litem?”
“No thanks.” She rolled her shoulders slightly, wincing at the soreness.
“Any pain?” Dennis questioned, watching her carefully. “Scale of one to ten?”
“Maybe a four? I’m guessing it’s just post-seizure stuff.”
“Never had one?”
“Nope.” She popped the ‘p’ with a shake of her head. “This is the first time I’ve ever even been in an ER.”
“Congratulations. Let’s try and keep the repeat visits at zero.” He keeps his tone as neutral as possible. “What medications are you on?”
Katie rattled off the usual spiel; multivitamin, birth control, allergy meds in the spring.
“Scent blockers of any kind?”
“A neutralizing spray before my heat.” She hesitates, biting her lip. “And…a suppressant. Just started it this weekend.”
“What color were the suppressants?"
“Um.” Katie squinted as if she was trying to visualize the pills. “Pink? They’re huge. Horse-pills.”
Dennis nodded, typing it down quickly and smiling as reassuringly as he could at her. “Thanks. That will help us figure out which one it might be. Is there a primary care that prescribed them?”
The omega swallowed, avoiding eye contact. “What’s your definition of prescribed?”
Dennis stopped typing. Took a deep breath, mentally prepping for this conversation.
“Hospital policy dictates that I have to call Omega Social Services,” he said quietly. “Suppressant use without a physicians consent-”
“I know it’s stupid, I know I was dumb. But-” Katie clenched and unclenched her fist. “The last thing my partner and I need is someone coming to us and trying to put me in a conservatorship.”
“That’s not the goal,” Dennis said gently. “Conservatorships are few and far between anymore. We only see that in extreme cases of neglect or self harm. The goal is to see if there is a larger threat to your well being that we don’t know about.”
“My partner is an omega,” Katie admitted. “Their heat is coming on in a week. I just wanted to make sure that I didn’t have a sympathy heat.”
He nodded, hoping he looked unfazed. That wasn’t the concern, not to him. The concern was what the fuck those pills had done to her system before the seizure had hit.
“Then that is something you can tell Social Services and see what resources and next steps they have to guide you. Both of you.”
The rest of the questions are answered quickly and Dennis orders another round of fluids and anticonvulsants. He leaves the curtain aiming to find three seconds to maybe get something to drink and instead runs face first straight into his chief.
Well, face first if Dennis wasn’t cursed with a size that made him an easy target. Instead, his face practically slammed into Dr. Robby’s chest.
“Easy. What have I said about running in my ED?”
“That I need to be faster if I don’t want you seeing it.”
Dr. Robby huffed out a laugh. “That was a joke.”
“It was a bad one.”
He grinned up at the man, pretending his heartbeat didn't immediately start to quicken under the weight of those brown eyes.
The alpha nodded at the curtain. “Any updates?”
“Did Mohan update you at all?”
“You were the one that did patient history, didn’t you?”
“Oh. Well, yeah, Katie Price, twenty six year old female omega. Seizure in chairs, no history of any convulsion spells before today. Mild fever, responding well to anticonvulsants and fluids." He pretended to be very interested in the floor for a few seconds.
“And?” Dr. Robby prompted.
“And she admitted to taking a suppressant," Dennis said. “Not prescribed.”
“She mated?”
“No.” Dennis fidgeted under the careful stare. It was always so damn hard to admit the things his patients tried to keep under wraps to the attending. “Partner is also an omega a week or so out from their heat. She was attempting to avoid a sympathy heat. Social Services is on their way down.”
“Good.” Dr. Robby’s head tilted, scanning over Dennis’s frame. “What’s bothering you?”
“Nothing’s-”
“Come on, Whitaker. Your scent might be subtle but you wear your emotions on your sleeve.”
Dennis resented that. He was excellent at hiding things.
Still, he sighed heavily, shoulder slumping in defeat. “This is the third one today. It’s always the same. Pink pills that are larger than normal. Seizures after a few doses. We’re probably looking at 800mg at least of a new suppressant.”
“The best we can do is contact the authorities and tell them what we know. Maybe we can get a patient to bring a pack in.”
“They’re having grand mal seizures,” Dennis said slowly. “And the best we can do is hope the cops do what they’re supposed to?”
Dr. Robby at least looked equally grim about it. “Until we get more information? Yes.”
Dennis nodded once, twice, before rolling his eyes.
It made Dr. Robby grin, reaching out to pat his shoulder. “I know. Not ideal. But I gotta say, it’s nice to see a beta med student taking such initiative in omega patient care. I know that it’s not easy but you do well. Usually I’ve had to fuss at students by now.”
Dennis shrugged in response. Hoping it sent the signal of Jesus Christ stop touching me. “They’re just like any other patients.”
“Exactly why I like you so much.” Dr. Robby squeezed his shoulder before removing his hand. “Call up to Omega Med and tell them they’ve got another suppressant victim coming up. Then maybe try to get out of here before ten at night, yeah?”
“Is that an offer to skimp out on handoff?”
“And funny. Better cross your fingers they’re not short staffed tonight.”
Dennis groaned at the hint of a jinx as Dr. Robby just grinned and left him alone at the workstation.
Social Services came and went in pleasant timing, no formal reports being filed. Dennis made sure to mention the reasoning and it seemed to ease the concerns. Katie’s partner arrived right as they were taking her up to Omega Med.
He was just about to finish his charting on the case when his roommate slid up beside him. “I heard about the seizure patient.”
“Katie,” Dennis corrected without thinking. Trinity didn’t miss a beat.
“How’s she doing?”
“Better. Heading upstairs. Should be discharged in a day or so.” Dennis rubbed his eyes tiredly. “And hopefully Omega Med has some sort of update on the detox process from these new suppressants. I don’t know when they hit the street but we’re getting more victims every single shift.” “Even if we did know, there’s nothing we can do. Unregulated suppressants are a practice as old as Dr. Robby.”
“Don’t let him hear that.”
“He’ll live. Hey, you want to come out to dinner? Round of drinks to follow? Crash is coming from her orthopedic hellhole to hang out.”
“I’m good. Headache.”
Trinity tilted her head. “Wow. That’s so convenient. The fourth time I’ve asked you to come out and the fourth time you’ve had a headache.”
He flashed her a grin. “Keeping track of me? That’s sweet.”
“I’m keeping track of how much you clearly hate me. Look, I know you’re not-” Trinity waved her hand through the air. “I know betas are loners, but I’m a pack animal. Socialization is good for me. It might be good for you too.”
“We can socialize at the apartment.”
“Never mind,” Trinity sighed. “I’ll rally. Alone. With Crash and whoever the fuck else decides to show.”
He patted her back in fake sympathy. “There, there. I’m sure you’ll find a nice pretty omega to keep you company in my absence.”
“If only,” she mumbled before shoving his hand away and moving towards one of her patient beds.
Selfishly, Dennis hoped no one would be coming home with her. The last thing he needed were sounds of a clearly satisfied omega with another overly eager omega.
Trinity didn’t have a type, but she did seem to enjoy having another omega in bed with her over an alpha. Even the occasional omega. The only alpha she ever brought over was Garcia, and that was just for her preheat. They had graciously gone to Garcia’s for her actual heat and Dennis had spent the week in silence.
It was awful.
He walks through shift hand off with Ellis, his preferred night shift resident. She’s funny but still no nonsense. The attitude of a well regulated alpha, the only one of two on the night shift.
The other being Dr. Abbot, who Dennis prefers to avoid like the plague.
It’s just something in his stare. All knowing, a little too smug, just too predatory to be safe. Too alpha-y for his taste. Unlike his mate, Dr. Robby, who was an alpha in a more…muted sense. Dennis had seen him lose his shit once and it had been decidedly enough to make him do everything in his power to not have it happen again.
Dr. Abbot liked to play with his food. Dr. Robby would attack when provoked. Dennis did his best to be uninteresting as a result.
The pounding in his temple takes precedent over saying any arbitrary farewells for the night. Accompanied by the cramping he can feel building, his only goal is to make it home before he collapses in public.
The bus is empty and the ride home is quiet. He’s grateful for it, leaning his warmed head against the window and trying to breathe through the muscles contracting in his stomach.
Routine is the reason he makes it off at the correct stop, finding his keys, making it to the elevator to head up to the apartment. It’s what gets him inside, the door shut and locked behind him, before he stumbled down the hall to his room.
It’s what makes him manage to pull the small baggie with bright pink pills from their hiding spot in his closet, buried in a box with old clothes from home.
The pills are large. Horse pills that used to take him forever to be able to swallow. But eventually, it got easier. He’s swallowed them dry before, forcing them down, clearing his throat for what felt like hours after. But they’re also effective. That’s what really matters. The relief is nearly immediate. His headache subsided. His vision cleared, cramps gone, shakiness fading.
Something lingers. Something warm and cedar scented. Leather and pine. Hints of apple and motor oil and something muskier.
Two very distinct alphas flashed through his head. Eyes and hands and He winced, sitting down, trying to forget the scent of them.
“Not happening,” Dennis muttered, curling up on the bed in exhaustion. “Not happening. Not needed. I’m not that. I’m not that.”
I’m not that. I’m not that. I'm not that.