Chicago Med fic: Resolution (1/7)
Title: Resolution
Disclaimer: Not mine.
A/N: Set post S6, AU of S7. Sequel to Restitution. Fills my PTSD square for hc_bingo. Unbeta’ed.
Summary: Will continues to figures out who he is, what he wants, and who he can be.
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
-o-
It didn’t help matters that the job was excellent.
He’d done his reading, so he knew the hospital was one of the nicest in the area. It was by far the nicest one sponsored by the organization. It was the largest, with distinct wings, and it had some of the most advanced technology on the whole continent. Several doctors were conducting cutting edge research there of international regard, and Will’s ED?
It was beautiful.
It was spacious. There were no paper charts here. The staff was trained, polished and well equipped. The lights never went out, and there were always supplies in the carts.
It was nothing short of heaven.
He was grappling with the utter perfection of everything when he was called into the office for his first meeting of the day. He was slated to meet his new boss, the hospital administrator. This was a position he was inclined to respect. At the last hospital, the administrator had been killed in action. Before that, Goodwin had fired him.
Will would like to establish a good working relationship that didn’t result in death or termination.
The second he met her, however, he was hesitant to believe it was possible.
“So you are my new ED chief?” she asked, not bothering to get up from behind her desk as he walked in. Without any effort to greet him, she scowled at him over the top of her glasses. She spoke good English, but her accent was telling. Denmark or the Netherlands, he speculated. “I thought you’d be older.”
It was said dismissively, and Will stopped opposite her, not sure if he was supposed to sit or stand.
She paid him little heed, going back to the stack of paperwork on her desk. He waited, feeling uncertain, as she continued to scrawl her notes.
“Well, sit, if you must,” she said, not sparing him another look.
He glanced around, feeling conspicuous, but he finally sat down. The woman was neat and tidy. Her hair was short and kept meticulously, blonde flecked with gray. She wore no makeup, and there were no adornments to her jewelry or clothing. She wore a simple pair of blue scrubs and a medical jacket. The inscription on her chest pocket read, Karen Dunst, MD. Chief of Staff.
For several more moments, Dr. Dunst continued her transcriptions. After turning another page, her mouth drew together tersely. Putting her pen down, she looked up. This time, she took off her glasses and seemed to look at Will fully for the first time. Her visual assessment suggested she was less than impressed. “Dr. Halstead, is it?” she asked.
“Yes,” he said quickly, sitting upright and eager to please. “Will.”
She nodded, but showed no signs that she actually cared at all. “You served for four months already?”
“Yes, with Adam Goshit,” he said.
Her nose wrinkled just slightly. “Dr. Goshit and I are acquaintances,” she said, and Will was beginning to suspect that the relationship wasn’t particularly friendly. She tipped her head to the side. “Though I was sorry to hear about the latest incident. That particular facility has been prone to such things in the past, so I was pleasantly surprised to see that the loss of assets was minimal this time.”
That was a rather clinical assessment of the death and destruction, and Will wasn’t quite sure what to make of it. “Well, there was still a significant death toll--”
She shook her head, refocusing herself rather brusquely. “It is up to the board to continue such assessment for viability and risk acceptability.”
Will sat back, not sure what to even say to that.
Fortunately, no reply was expected of him. In fact, he got the sinking suspicion that one wasn’t even wanted. This doctor was making Ms. Goodwin look like a shrinking violet.
“I abide by the board’s decisions, even when I do not agree with them. I know my place,” Dr. Dunst continued with a hard look at Will. “Given the scarcity of information in your file, I am hesitant to assume you have the same, necessary mindset.”
Will blinked quickly, and leaned forward intently. “I assure you, my intent is to be a team player.”
His quick promise seemed only to make her more skeptical. “Your words are quite meaningless,” she said blandly. “As I said, the information in your file is scant. The glowing reviews from Dr. Goshit are notwithstanding. The file only encapsulates a small segment of your career. Where were you before joining us here?”
“Uh, Chicago,” Will said. “At Chicago Med.”
That kind of name drop usually held some weight, but not for Dr. Dunst. “For how long?”
“Just under 10 years,” Will said. He sat back, trying not to show just how uncomfortable this was starting to make him.
“Ten years,” she repeated. “Therefore, you would have been an attending? In a large city of decent repute--”
“I’m really not sure--”
She looked increasingly bored with the back and forth. “You abandoned your career at a critical juncture,” she said. “Moreover, you came here, which by all accounts is a step back in your forward trajectory. That suggests that you are incapable of making a commitment or were insufficient in your performance.”
Will’s jaw worked hard, and he felt his heart flutter a little. It was unsettling how correct her assessment was. “Or,” he posited in desperation, “I was just hoping to make a difference.”
She scoffed lightly, as though he’d told her a joke. “Pure altruism is uncommon in this world,” she said. “And it is no matter. You are here, and I am to make the best of it.”
Will took that as an opening. He sat up again, attempting to forge a smile. “Well, I assure you, I am ready and willing to serve--”
The unimpressed look on her face quickly took the wind out of his sails. She held up her hand. “Please, spare the theatrics, Dr. Halstead,” she said. “You are here, and I have no choice but to accept that. But do not confuse my acceptance with my approval -- much less my trust. You got this post because my superiors believe you have earned it.”
“Well, I have been fully committed--”
She shook her head again, cutting him off unceremoniously. “Do not assume to finish my thoughts,” she said. “They think you earned it. I follow their orders because that is my place, but do not conflate their trust with mine. If you work here, you will work hard, and you will follow my orders without question or delay. If you do not comply, I will not hesitate to transfer you.”
It was a cold delineation, and Will realized that this Africa fallback plan wasn’t foolproof. Four months of progress was just four months of progress. Will had pulled off four months before. Four months with his best friend. That was easy.
The long haul, that was the difference. Flourishing under conflict, that was the test.
If anything, her doubt was deserved. Her mistrust was with reason.
Stiffly, he nodded his head, keeping his eye contact steady. “Understood.”
Across from him, Dr. Dunst narrowed her eyes. She rocked back in her chair for a moment, lacing her fingers together thoughtfully. “See, I hear you say that, but I do not think you truly mean it,” she said. “This hospital -- my hospital -- is the best in the country, and we only achieve that through discipline and hard work. You will do more cutting edge work here, that is true, but there is zero room for error.”
“I understand high standards, I really do,” Will said. “But medicine isn’t an exact science.”
“That is a cliche doctors say to comfort themselves,” Dr. Dunst said. “Operating a hospital must be an exact science if it is to succeed. I will not let you compromise any element of what I am doing here. Do you understand?”
There were no shortcuts here. There were no shortcuts in redemption, then.
Will had to put in the work.
No matter what.
“Yes,” he said. “I understand.”
She gave him another long, appraising look. Though she still seemed to find him wanting, she finally inclined her head. “Very well,” she said. Then she picked up her pen again, turning back to her papers. “Now, go.”
With no other options, Will went.
He’d had Adam’s trust even when he probably didn’t deserve it, but he was starting from scratch with Dr. Dunst. It was time, then, to sink or swim.
-o-
Will wasn’t sure he was swimming, but after his first few days on the job, he was pretty sure he wasn’t sinking at the very least.
He spent his time at home studying the policy manuals, and he took pains to research every part of the hospital’s operation. He had memorized the name of everyone on staff, and he had a broad understanding of his daily duties, weekly duties and monthly commitments. He started to make a meticulous schedule for himself, mapping out point by point his daily commitment, accounting for time with patients, staffing issues, paperwork and financials.
On his first day, he introduced himself to the ED staff, and he scheduled a litany of one-on-ones to get to know each member of the nursing and doctor staff. With the techs, he didn’t have time to pull each one into an office meeting, but he made a point to meet and greet each one individually, just so he knew who was going in and out of his ED.
He had to build new connections, and he had to get a brand new lay of the land. In many ways, it was likely starting from square one again -- or worse. Adam had provided him a layer of support he’d taken for granted. There was no one to ask questions of now; there was no one to back him up. Will had to make his own decisions, and he had to stand by himself by those consequences.
The good news was this hospital was far more functional than the one Adam had run. With more funds and more staff, operations ran much more smoothly. Will didn’t have to reinvent the wheel here. He just had to make sure it kept spinning well.
This had a lot to do with the city. Adam’s hospital had been located in a poor section of town -- more or less, the slums. This hospital had a far more robust neighborhood, and that was evident in the number of patients who could pay their bills. As a result, the work hours were steadier, and there were more comfortable perks. The cafeteria food was actually tasty. The staff room was actually private. And Will had an office with an actual view.
Dr. Dunst, however, seemed intent to not let him -- or anyone else -- be comfortable.
Adam had run things his own way, and Dr. Salvo had been something of a non-entity. Back at Med, Ms. Goodwin had always had her say in things, but she’d granted a good amount of latitude to her employees -- a fact that Will had needlessly abused.
Such abuse wasn’t possible here. Dr. Dunst tolerated no latitude. Her morning briefings were always policy reviews, and her criticisms often stemmed from minor infractions. She said she was going to go easy on Will since he was new, but Will wasn’t sure what that meant. In two weeks, she offered not a single piece of positive feedback. Instead, he received harsh critiques and critical assessments.
And to think, he was making an effort to stick to the script this time.
Except sticking to the script wasn’t enough.
He needed to memorize the script.
He had to internalize it.
The script had to be second nature -- it had to be a part of him.
It was pretty clear that this placement, in all its posh comfort and cutting edge perks, was definitely going to be his hardest one yet.
-o-
Then, after nothing but sparse interactions with his new boss, she called him out of nowhere. The day was almost over, and Will had been diligently finishing his paperwork for the next day. When he saw Dr. Dunst’s extension on his phone, his stomach churned uncomfortably.
What policy had he let lapse?
Which protocol had not been followed?
Was it the extra acquisition order he had placed for more gowns? Had he been presumptuous to allow one of the nurses to switch shifts at the last minute? It had been a family emergency, and the gowns had been soiled by water damage from a leak that occurred before Will arrived, but still. Strictly speaking, there was room for criticism, and Will couldn’t prevent flashbacks to Ms. Goodwin’s office that fateful day nearly six months ago.
Maybe they had finally figured out that hiring Will was a mistake. It would always be a mistake.
The line was still ringing, and Will swallowed hard against the nausea. Whatever the consequences, he had resolved to face them. No matter what.
With that in mind, he took a breath and answered.
“Hello?”
Dr. Dunst was not one for small talk. In the two weeks Will had known her, every interaction had been one with an overwhelming economy of words.
“Dr. Halstead,” she chirped expectantly, not bothering to return the greeting or confirm her identity. “I know that you are about to finish your shift in the ED, but you are going to be required to work the night shift upstairs in the ICU. Our attending has come down with a case of the flu, and three others were already traveling for a critical care conference out of the province. As you should know, protocol demands--”
“--for another doctor of equal or greater rank to fill in,” Will said, finishing that section of policy code for her. “If someone in the discipline is unavailable, the closest option should be considered.”
“Yes,” she said, only sounding surprised for the barest of seconds. “The ICU and the ED are not perfect fits, but given your lack of seniority among the senior staff, I am obligated to inform you that the task does fall to you for this evening. I will assume that that is acceptable?”
The question was one that had only one answer, and Will wasn’t about to pretend otherwise. “Of course,” he said quickly. “I just have to finish up my paperwork from the ED shift, and I’ll be right up.”
There was a small sound of her breathing on the other end, and then she added, “You are new to this hospital, and you have no background in ICU care. I understand that this does put you out of your element, and I have some sympathy for that. If there are any critical issues you feel uncertain about during the shift, you are free to call me directly without any negative reflection on your performance.”
Will sat back, a little stunned by the offer. It wasn’t overtly demonstrative, but Will could read between the lines. She was offering to play backup.
It was an offer of kindness, actually.
“Thank you,” he said, remembering to speak. “I’ll definitely keep you informed if something unexpected pops up.”
He could almost see her brusque nod, even over the phone. “Very well,” she said. “Good night, Dr. Halstead.”
Rocking back in his chair, Will had to think that his good night was just starting.
-o-
Although he’d only been on the job officially for two weeks, Will had taken great pains to know every inch of the hospital and the personnel in every ward. That wasn’t to say he was on a first name basis with everyone, but he’d made a lot of progress. At the very least, he wasn’t a stranger to the people up in ICU -- and they weren’t unknown faces to him, either.
Such familiarity had been a matter of course as he tried to prove he could hold his own under Dr. Dunst. But it also yielded very practical dividends on the job. It always helped to have a good rapport with other departments -- doctors didn’t provide the best care to patients when they practiced medicine in a silo. Plus, when you needed to squeeze someone up into an overbooked ICU, it helped to have some favors to play.
And, when you had to pinch hit, at least you knew that the people there would have your back -- probably.
He knew that Dr. Dunst had offered her support, which had been a nice gesture, but Will didn’t intend to take her up on it. No, he’d been called into play, and it was his goal to step up. If this was a challenge, he intended to meet it. Dr. Dunst wasn’t impressed by just getting the job done. He wasn’t sure what he needed to do to impress her, but he was pretty sure that calling her in wouldn’t probably get him there.
Of course, doing the job poorly would also be counterproductive, so Will was going to have to do everything exceptionally -- and by himself.
While adhering to the strictest rules he’d ever worked with.
No problem.
As a department head, Will was well aware that he didn’t have the luxury of trepidation -- which was ironic, really. He’d spent most of his career mired in overconfidence. Now that he had the common sense to second guess himself, it wasn’t something he could afford to indulge.
Therefore, Will did the only thing he could do. He finished his paperwork and went upstairs, checking in with the ICU charge nurse and personally greeting the other attendings and residents on duty that night. Given his fast-tracked knowledge of hospital operation and his general expertise as a emergency room physician, he wasn’t totally out of his depth here. But he didn’t want to be presumptuous.
Instead, he monitored patient care with a keen observance of all protocol, and he focused on being the best doctor he could while supporting the more experienced ICU staff already in place. When things felt overwhelming, he reminded himself why he’d become a doctor in the first place. If he was here to save lives, then that was what he was going to do. Save lives, one at a time. In its purest form, medicine was beautifully simple, and that had always been where Will thrived.
Unfortunately, real world medicine did not always exist in its purest form. In practical application, medicine was rarely beautiful or simple. That was how Will had gotten here in the first place. Will had to practice medicine in expected boundaries and exterior expectations. He had done his best to balance those things, but it never got easier.
Six months in Africa, and he still had no idea what he was doing.
So, when the alarm sounded for a code on a patient in bed 3, Will was up. He knew how to run a code, of course, and a cursory glance at the patient’s file gave him sufficient background to provide the necessary treatment. 46 year old female, two days post op. She had completed an intricate back surgery, which had left her spine precarious as it healed. Complete immobilization had been required, but now all indications were that she had thrown a pulmonary embolism.
First, Will restored the heartbeat, supplementing with manual ventilation. He added an order for collodion thinners as they moved in the scanner to visualize the chest for size and placement of the clot.
He was just confirming the clot when the surgical resident came in, having been in on the initial procedure. When the resident saw what Will was doing, he looked mortified.
“She’s on strict mobilization,” the resident protested.
“She also crashed,” Will said, adding a note to the file. “The rules of triage would apply.”
“Normally, yes,” the resident said, sounding nearly beside himself now. “But this patient, do you know who she is?”
It felt like a trick question. Will knew who the patient was from her chart, but clearly, there was some context he was missing here.
“Ariana Mu?” the resident asked, his eyes nearly bugging. “Academic elite, wealthy family with massive donation ties to this exact hospital--”
“Okay,” Will said. “All the more reason we should help her now.”
The resident scoffed. “We need to back up here--”
The notion was quickly put on hold when the monitors sounded again. “Damn it,” Will said. “She’s crashing--”
He got himself in position to start chest compressions once more while the nurse obediently continued ventilations.
“You can’t do that!” the resident objected loudly.
“Someone get the epi on board,” Will said to the nurses. He shook his head at the resident. “Why not?”
“I have worked with her since her admission,” the resident said. “She has expressed to me repeatedly that she does not want to suffer any deficits.”
Will continued the rapid rounds of pressure while the nurse injected the meds into the IV and the monitors continued to chirp. “So?”
“So?” the resident said. He pointed at Will. “What you are doing -- it could paralyze her!”
“I know that,” Will said. “But I read her file. She doesn’t have a DNR.”
“Well, no--”
Will reached for the paddles. “Let’s start at 150 -- clear!” he said, shocking Ariana. He glanced at the resident. “In your background, did she object to any specific measures?”
“No--”
“No response,” the nurse reported.
Will made a face. “Give me 200,” he said, quickly shocking her again. “And she understood the risks?”
“Of course,” the resident said. “But if we paralyze her--”
“Still nothing,” the nurse reported.
Will started doing compressions again, feeling the pressure start to build. “Our objective is to keep her alive,” he said. “If there’s no DNR, then I’m finishing this code.”
The resident shook his head abjectly. “But Dr. Halstead--”
“Another miligram of epi, please,” Will said. Then, to the resident, he continued. “I understand your desire to follow the patient’s wishes -- I really do -- but we have to respect their actual wishes and not our interpretation of those wishes. She knew the procedure and its risk, and she didn’t sign a DNR.”
The resident backed up a step. “I can have no part in this.”
“Fine,” Will said, reaching for the paddles again. “Then I’ll take full responsibility. Let’s go to 200 -- clear!”
The resident was already out of the room, when Will finished, and this time, the nurse smiled. “Sinus rhythm.”
“Good,” Will said. “Now, we’re going to have to get her up to the cath lab immediately -- try to bust this clot before it moves to her brain and we’ve got serious issues. I’ll call down, but you get her prepped to move.”
The nurses acknowledged his orders, and Will started out to the desk to make the call and update the chart. To his surprise, he found the resident coming back down the hall, nipping at the heels of Dr. Dunst.
Dr. Dunst didn’t look pleased, but she was the kind of person who never looked particularly pleased. The resident was talking to her in an animated fashion -- it wasn’t hard to figure out his topic -- and Dr. Dunst listened to her jaw tight and her eyes ahead.
Will felt a momentarily pang of trepidation, but there was nothing to be done for it now -- any of it. He didn’t bother with pretense, keeping his feet planted as she approached.
“Dr. Halstead,” she said. “Dr. Remay is quite concerned about your treatment plan for Ariana Mu. Can you please tell me what occurred?”
“Sure,” Will said. “Ms. Mu had been recovering, two days post op. Her SATs were less stable this evening before I was on duty. She was not my patient, but when she coded, I was the doctor available. I reviewed her chart, and then followed code protocol.”
It was an answer that was direct and to the point. He had no other defense, and he wasn’t interested in justifying himself.
Dr. Dunst, at least, seemed to appreciate that approach. “As would be expected,” she said. She turned to the resident. “And you have concerns about Dr. Halstead’s clear actions here?”
“Yes,” the resident said. “I have worked with Ms. Mu for some time now. She’s one of our biggest donors, and an intellectual elite. She repeated has expressed how important it is for her to stay without deficit, and Dr. Halstead’s actions put her at risk for paralysis.”
“As is necessary to run a proper code,” Dr. Dunst said. Her forehead furrowed as she studied the resident. “Did Dr. Mu have a DNR? Were there any special notes regarding her resistance to certain procedures or interventions?”
The resident flattened his lips. “No.”
Dr. Dunst frowned now, shaking her head. “Then, tell me. What would you have Dr. Halstead do?”
“Consider the patient’s wishes!” the resident insisted. “He comes in without any background -- he’s not even a member of the ICU staff.”
Will felt his cheeks redden, but Dr. Dunst was plaintive in her reply. “The patient’s wishes were made clear in the file,” she said. “According to protocol, all measures should be used unless the patient specifically objects. I assume you discussed the risks of the initial procedure with her?”
The resident went a little wide eyed. “Of course.”
“Then, I fail to see the problem here,” Dr. Dunst. “This is a procedural question that has a clear delineation of cause and effect.”
The resident scoffed with the self effacing confidence that Will remembered. “Ms. Mu is our biggest donor,” the resident said again, voice punctuated with frustration. “And she’s brilliant.”
“And she’s still a patient,” Dr. Dunst said with a dismissive shake of her head. “Dr. Halstead operated in this case exactly as I would, and frankly, you are lucky he was here. Your lack of action and hand-wringing would have killed her.”
The resident’s mouth dropped open, and his face burned red. He looked to be on the verge of arguing, but Dr. Dunst was clearly unswayed.
“That is all,” she said curtly. “You still have patients to attend, do you not? I suggest you go make yourself busy before I seriously consider a deeper review of this case, a review which I am quite confident would not go in your favor.”
Mouth snapping shut, the resident turned hard and fumed down the hall. Will watched him, somehow both amused and sympathetic. He’d been there. Hell, that was what had gotten him here.
Dr. Dunst drew a breath, and she looked at Will. “Where are we at, then?”
“Just transferring Ms. Mu down to the cath lab,” Will said. “I’m optimistic we can get the clot there before it causes any more problems.”
She nodded with disinterested approval. “And you are confident in your choices here? Or is a deeper inquiry still warranted?”
It was an interesting question, one that posed a semblance of skepticism and a good dose of trust. He wasn’t young and brash anymore, and the mere idea of overconfidence could be enough to derail him sometimes. But Will had read the file. And he knew the protocol.
He had played this one right down the line.
So, he shook his head. “I followed protocol completely,” he said. “There was no other way to play this one.”
“Very well,” she said. She nodded, pursing her lips with her eyes set in a facsimile of a glare. Yet, somehow, she continued, “Good work, Dr. Halstead.”
He didn’t know what to say. Dumbly, he just stared at her.
She shrugged, as if uncomfortable with the silence. “Anyway,” she said. “I trust you have things well in hand? I will leave you to it.”
And Will could only watch her go, wondering if this was what success felt like after all this time.
-o-
The good news was that Ms. Mu’s procedure in the cath lab was successful. The better news was that by morning, she was awake and cognitively intact by morning. She could also still move her extremities, and repeat scans suggested that there was no sign of damage to her spinal cord.
As he was wrapping up to finally go home, the resident in question came to him. It was funny to Will how young he looked, and it occurred to him that he wasn’t a bad doctor. He was dutiful and conscientious, and he cared about his patients -- probably more than he should. He’d been wrong, overall, but in the moment, from his perspective, it made more sense that Will had been willing to grant him.
Doctors didn’t need to learn to care less. They needed to learn to care within boundaries. Arrogance wasn’t thinking you could do everything. It was thinking you always knew best.
And it was so, so easy to do.
You felt it with every beat of your heart, every voice of reason in your head.
The line between being a good doctor and a terrible one was much thinner than people realized.
Much thinner than Will had allowed himself to consider until now.
With a steadying breath, the resident looked at him. “You didn’t tell her what I did.”
Will returned his statement quizzically. “You didn’t do anything. I was the doctor on call for that code.”
But the resident was already shaking his head. “I tried to stop you. I jeopardized her care, and I just went in there, and she thanked me for saving her life.”
“And?” Will said. “Weren’t you in on the surgery?”
“Yes,” the resident said. “But we both know I would have killed her.”
“We don’t know that,” Will said. “You were expressing doubt, not making the executive call. It’s different when you realize that the buck stops with you.”
“No, no way,” the resident said. “You’re giving me an easy out, and I don’t deserve it.”
“Well, if you’re giving yourself a hard time, then what do you need it from me for?” Will asked with a pedantic shrug.
The resident scoffed, still shaking his head. “I don’t get it.”
“I know,” Will said. “I didn’t either. Which is why I’m not the one to call you on it. Dr. Dunst, on the other hand, might. So I’d watch yourself for awhile, just to be sure.”
He was willing to leave that as good enough, but the resident looked him down one more time. “How did you get on her good side?”
Will stopped short, this time genuinely surprised. “What?”
“How did you get on Dr. Dunst’s good side?” he asked. “She literally scares the crap out of everyone, but she was positively glowing to you last night.”
Positively glowing was a funny description for such disinterested behavior, but in the few short weeks he’d known her, he couldn’t pretend like the assessment was entirely off. He just hadn’t noticed. He hadn’t let himself notice.
And this kid was just a resident.
Will shook his head. “I was just doing my job,” he said, setting off to leave now. He looked back one more time. “Just like you need to keep doing yours.”
-o-
Will couldn’t pretend like he didn’t like to have his ego stroked -- of course he did, and of course that had been one of his flaws as a doctor and as a person. He could be too confident -- and that could make him cocky. Simply put, his overestimation of his own worth had always been an obstacle to real success.
Therefore, he didn’t take Dr. Dunst’s approval as a validation.
No, he took it as a challenge.
It showed that she wasn’t an impenetrable wall of self control and medical policy. Dr. Dunst could be impressed. Dr. Dunst could be ingratiated. Dr. Dunst might actually come to respect him someday.
That required even more work, even more dedication -- even more everything. Will had to master every part of medicine, from patient care to staff management and beyond. His hours? Had to be longer. His patient outcomes? Had to be better. His budget gains? Had to be palpable.
Because he knew that Dr. Dunst was impressed by flashy saves, but earning her trust was more than that. There were plenty of talented doctors in the world, but Dr. Dunst was looking for something else. Something more.
A doctor was just one part of the system, after all. Will had never fully appreciated that. Sure, he’d leveraged it when he needed to, but it couldn’t be a system of convenience. In order to really operate at the highest level, each part had to be cognizant of the rest.
Will didn’t need to be a better doctor.
He just needed to understand the system more.
He had always worked the system, but now he had to work for it.
It was the right thing to do, he decided.
And maybe -- just maybe -- he might finally show Dr. Dunst that he was worth something after all.
-o-
Hard work was hard work, nothing more. It wasn’t fancy; it wasn’t flashy. It was just blood, sweat and tears.
And hours.
Will was the first one there in the morning. He clocked in before his shift, and he had his charts done before anyone else had started. He worked through his lunch, and he was always available for a consult, a second opinion or a crisis of conscience. He was a shoulder to cry on. He was a voice of reason. He was the leader in every possible way. When the rest of the day shift clocked out, he was still there. He was the last one to leave, so much so that the night shift knew him by name as well.
It wasn’t clear that any of this made an impression on Dr. Dunst. In fact, there was no indication that she’d noticed his hard work at all. Every time they interacted, she was professional but cold, and she never offered him the faintest of praise. Her preference seemed to be to rarely deal with him at all, and she always had a litany of questions to assess his professional choices without any personable chitchat.
Clearly, Dr. Dunst was going to be a hard sell. Or, possibly, an impossible sell. Will found that a little discouraging, but there was no recourse for it. To let up now would only validate her doubts about him, and there was no way he wanted to make his position even more tenuous than it already felt.
However, everyone else was starting to take note.
It didn’t take long for the attending to open up to him. He developed a quick rapport with all of them, and that sense of camaraderie worked its way down the whole staff. Within several weeks of his arrival, he saw dramatic improvements in the overall functionality of his department. Work was done faster; patients were treated with more efficiency.
And not just the practical things. There were other changes that were harder to quantify. Staff members seemed happier. Their diagnostic skills quickly excelled. They weren’t just treating more patients. They were treating patients better.
The ED also enjoyed a newfound give and take with the rest of the hospital. Cultivating a relationship between multiple departments was no easy task. Even at Med, it had been an imperfect process. But Will made time to touch base with every department head in the hospital, and soon he was on a first name basis with each and every one. It took a little longer to learn all the residents’ names, but one month into his tenure, and he had established himself as a key network player between himself and every other department in the hospital.
The cost on his personal life, of course, was palpable. In other words, he didn’t really have much of a personal life anymore. For as nice as his apartment was, he rarely spent time in it. It was a home base for showering and eating, but little more than that. His breakneck pace was tiring, to say the least, and there were moments when he thought he couldn't keep it up.
Quitting wasn’t a privilege he had anymore, though.
It didn’t matter if he was tired.
It didn’t matter if he was lonely.
Will had a job to do.
-o-
When Will had started at Adam’s hospital a few months ago, the goal had been to serve a very underprivileged part of the community. The organization specifically targeted these areas to bring up the standard of care. It was hard work, with very little profit. It also tended to be quite thankless, but Will had taken that for what it was.
Dr. Dunst’s hospital, by contrast, was the exemplar. This hospital was the endgame for the organization, starting off small and poor and building a reputation large enough to attract donors and big name patients.
A destination hospital, as it were.
That had never been Will’s thing, necessarily. Sure, a little attention felt good now and again, but he was wary of it all by now. He had come to Africa to get away from his own impossible ego. He’d been trying to disappear.
Trying and succeeding -- a little too much apparently.
Because one day at work, a VIP patient came into the ED and requested Will by name.
During his short tenure at the hospital, VIP patients had become something of an ubiquitous reality. He’d encountered them before, mostly at Med and in New York. Of course, in those contexts, usually the VIPs were assigned to more important doctors -- and that had never bothered Will. Growing up in Canaryville, he’d come at things with a bit of an inferiority complex. It wasn’t hard to tell when he was overcompensating.
That said, now that he was Chief of the ED, the VIPs were his business -- almost to the point of absurdity. Because if Dr. Dunst loved her protocol, she valued her VIPs more.
And now that Will was in charge of the budget for the ED, it wasn’t hard to see why.
One VIP patient could fund his department for a month. More than that, it had something of a domino effect. One VIP patient could lead to two VIP patients. As the connections grew, so did the hospital’s notoriety. That was why, despite all commitments to equal care, Will dropped all his paperwork to go take Mr. Alawe’s treatment into hand himself.
Mr. Alawe was clearly in his late 50s, but he seemed to want to appear younger. He was wearing high end workout clothes, the kind that wealthy men wore to make it look like they were still average people who could actually sweat. Although he didn’t seem to be in any particular distress, his foot was propped up on the bed and copiously swathed in ace bandages and ice packs.
“Mr. Alawe,” Will said, coming in and offering his hand with a broad smile. “I understand you hurt your ankle today.”
Mr. Alawe smiled brilliantly. “Yes, I am afraid it is true!” he said with impeccable English. “I was playing racquetball, but I am not quite as nimble as I used to be.”
“It happens to the best of us,” Will said, turning his attention to the damaged appendage. One of the residents had already completed the history and the background, and Will confirmed that the orders had appropriately asked for the right tests. The x-ray was already on file. “All part of the price we pay to stay healthy.”
Mr. Alawe laughed roundly. “Or the price we pay for getting old!” he said jovially. “But it is not so bad.”
Will started to unwind the bandages, setting the ice aside for a better look. “Your pain is better?”
“No, no,” Mr. Alawe said quickly. “I just meant that it is fortuitous. I had heard there was a new ED Chief, but I had not met him yet to find out for myself. Then, just like that, I hurt my ankle! Surely, it is fate for us to meet today!”
Will smiled politely, looking at the x-ray that had been produced. “I’m not sure I’d call it fate, but at least it’s not broken,” he said, turning back to the foot in question. He palpated it once more. “You still have good range of movement, so I have no reason to suspect that there’s any kind of ligament damage. Probably just bruising to the muscle.”
Mr. Alawe, for all that he’d come in for, didn’t seem remotely interested in Will’s diagnosis. “Most of the doctors here are quite active in the social scene,” he continued. He gave Will a curious look. “And I know all of the other department heads by name! Dr. Dawson comes to my weekly poker game -- no money exchanged, I swear! It is just for fun. And dear Dr. Lorio is quite the golfer!”
“I’m sure she is,” Will said reasonably. He reached for some fresh medical wrap. “I’m going to go ahead and wrap your ankle, and we’ll give you something to help you get around while staying off your feet. We won’t need anything as dramatic as a boot, but I can get PT in here to fit you with a stabilizing brace until your ankle is healed.”
Mr. Alawe was hardly listening. “Oh, and the hilarious Dr. Ngo! He is an avid patron of the arts! I had him over for the opening of an exhibit at the gallery just two weeks prior!”
“Well, it sounds like you are a staunch supporter of this hospital, which is wonderful,” Will said, starting to wrap the exposed ankle. “Are you feeling any discomfort?”
“No, no,” Mr. Alawe said. He bit his lip and tipped his head to the side. “And what about you, my dear Dr. Halstead? What are you interested in?”
“Me?” Will asked, He glanced at the man in a bit of surprise as he finished the wrap. “I’m just here to do work, Mr. Alawe. That’s all.”
“That is an admirable work ethic, it is!” Mr. Alawe resounded. “But you are a smart man, yes? You know that life is more than work.”
“I’m still new here,” Will admitted, securing the wrap now. “So I’m working on finding that work-life balance.”
Mr. Alawe winked at him with a conspiratorial air. “You are still young, yes? Young enough. And that red hair must make you quite popular.”
Will chuckled. “It does tend to stand out.”
“I just would like to know you better,” Mr. Alawe said. “I am always looking for new ways to get involved. I have too much time, too much money. It can make you lazy, it can make you stupid. I like to invest in good causes, good people--”
“I’m really not sure what you mean, Mr. Alawe,” Will said as deferentially as he could.
Mr. Alawe narrowed his eyes, the injured ankle all but forgotten. Will had been striving to provide idealized care, but Mr. Alawe seemed to have other goals in mind.
“Here,” he said, reaching into his pocket. He pulled out a business card, turning it over. Producing a pen from his pocket, he scrawled something on the back, and then he held it out to Will. “This is my card. My work number is on the front, and that is fine, because I have a very good personal assistant, but -- the number on the back! That is my private number! I will answer that one myself! Guaranteed!”
Will was reluctant to accept it, quickly going over in his mind the policy on personal interactions with patients. A phone number didn’t count as a gift, therefore Will wasn’t beholden. However, the exchange of a private number could indicate preferential treatment, which was prohibited.
That said, Mr. Alawe was holding out the card, and he knew the kind of sway patients of this caliber held.
Will accepted the card, bobbing his head forward. “Well, thank you. And, you know, if you ever end up in the ED again--”
“I will look you up!” Mr Alawe said, beaming proudly as Will pocketed the card. “Although, something does occur to me.”
Will perked up. “Do you have other symptoms you need to discuss?”
“No, no,” Mr. Alawe said. “But I am having a party in a few weeks.”
“Oh, well, your ankle should be fine by then.”
Mr. Alawe shook his head. “No, I am not thinking of my ankle,” he said. “But the guest list. Such things -- they are tedious -- but important! A good party must have the right guest list!”
Will wasn’t sure what that had to do with him, but if small talk was all that was required to make Mr. Alawe’s stay better, then he could spare a few minutes. “I’m sure a man like you always gets the best.”
“Oh, I do, I do!” Mr. Alawe agreed with enthusiasm. “But this one, you understand. This one is special.”
Will had no idea what that actually meant, and he momentarily wondered if this was just the kind of thing that was expected to be a topic of conversation when you reached a VIP status. He’d only been an ED Chief for about a month now, so the idea that he knew what he was doing was laughable. He was badly out of his depth here, and he knew it. Unlike most things, he couldn’t protocol his way out of this conversation.
He just had to try to be polite and hope that he picked up on enough social cues not to alienate one of the richest men in the city.
And, with all that, the only reply he could come up with was: “Oh?”
By making it a question, he hoped to imply that he was interested and not just completely confused. His efforts interacting with rich and powerful people was limited, and the last time he’d made an attempt, he’d ended up brokering a contract for a murderer and working as a CI.
So, you know, good memories.
“Oh, a little thing I host each year,” he said, flitting his hand through the air, even as he narrowed a keen gaze on Will. “Many hospital staff come, people from around the city -- the province. You know, the best of the best.”
Will wasn’t entirely sure what was being insinuated here, but the phone number on the back of the card and the casual indication of a party seemed to suggest that Will could be on the invite list.
That was ridiculous, of course.
Except Mr. Alawe was watching him -- almost hopefully.
Will laughed, backtracking almost immediately. “Well, I’m very busy, Mr. Alawe. Still getting my feet wet, so to speak.”
“All the more reason to get take, get your bearings, make connections,” Mr. Alawe said. “It is practically a conference for the medical elite!”
Will wasn’t sure how that applied to him, but he blushed appropriately anyway. “As I said, Mr. Alawe, the offer is generous, but my schedule just doesn’t allow for it.”
This wasn’t the kind of man who took no for an answer, however. He nodded, smiling like he knew something Will did not. “Just think on it. Talk to your boss. Maybe the good Dr. Dunst will give you the night off?”
“Oh, do you know Dr. Dunst?” Will asked, grateful for something else to discuss.
Mr. Alawe took his turn to laugh. “She must be a very competent doctor because she is not a very sociable person,” he said in a low voice. “But seriously. Think on it! Next Friday! If you want to be added to the invite list, all you must do is call that number, yes? Call!”
Will patted his pocket where the card was. “Well, I’ll consider it,” he said, mostly as a matter of being polite. He got up, reaching for the hand sanitizer on his way out. He turned back to smile one more time. “Good luck, Mr. Alawe. And if you experience any problems with that ankle--”
Mr. Alawe held up his finger eagerly. “I’ll know just who to call!”
Disclaimer: Not mine.
A/N: Set post S6, AU of S7. Sequel to Restitution. Fills my PTSD square for hc_bingo. Unbeta’ed.
Summary: Will continues to figures out who he is, what he wants, and who he can be.
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
-o-
It didn’t help matters that the job was excellent.
He’d done his reading, so he knew the hospital was one of the nicest in the area. It was by far the nicest one sponsored by the organization. It was the largest, with distinct wings, and it had some of the most advanced technology on the whole continent. Several doctors were conducting cutting edge research there of international regard, and Will’s ED?
It was beautiful.
It was spacious. There were no paper charts here. The staff was trained, polished and well equipped. The lights never went out, and there were always supplies in the carts.
It was nothing short of heaven.
He was grappling with the utter perfection of everything when he was called into the office for his first meeting of the day. He was slated to meet his new boss, the hospital administrator. This was a position he was inclined to respect. At the last hospital, the administrator had been killed in action. Before that, Goodwin had fired him.
Will would like to establish a good working relationship that didn’t result in death or termination.
The second he met her, however, he was hesitant to believe it was possible.
“So you are my new ED chief?” she asked, not bothering to get up from behind her desk as he walked in. Without any effort to greet him, she scowled at him over the top of her glasses. She spoke good English, but her accent was telling. Denmark or the Netherlands, he speculated. “I thought you’d be older.”
It was said dismissively, and Will stopped opposite her, not sure if he was supposed to sit or stand.
She paid him little heed, going back to the stack of paperwork on her desk. He waited, feeling uncertain, as she continued to scrawl her notes.
“Well, sit, if you must,” she said, not sparing him another look.
He glanced around, feeling conspicuous, but he finally sat down. The woman was neat and tidy. Her hair was short and kept meticulously, blonde flecked with gray. She wore no makeup, and there were no adornments to her jewelry or clothing. She wore a simple pair of blue scrubs and a medical jacket. The inscription on her chest pocket read, Karen Dunst, MD. Chief of Staff.
For several more moments, Dr. Dunst continued her transcriptions. After turning another page, her mouth drew together tersely. Putting her pen down, she looked up. This time, she took off her glasses and seemed to look at Will fully for the first time. Her visual assessment suggested she was less than impressed. “Dr. Halstead, is it?” she asked.
“Yes,” he said quickly, sitting upright and eager to please. “Will.”
She nodded, but showed no signs that she actually cared at all. “You served for four months already?”
“Yes, with Adam Goshit,” he said.
Her nose wrinkled just slightly. “Dr. Goshit and I are acquaintances,” she said, and Will was beginning to suspect that the relationship wasn’t particularly friendly. She tipped her head to the side. “Though I was sorry to hear about the latest incident. That particular facility has been prone to such things in the past, so I was pleasantly surprised to see that the loss of assets was minimal this time.”
That was a rather clinical assessment of the death and destruction, and Will wasn’t quite sure what to make of it. “Well, there was still a significant death toll--”
She shook her head, refocusing herself rather brusquely. “It is up to the board to continue such assessment for viability and risk acceptability.”
Will sat back, not sure what to even say to that.
Fortunately, no reply was expected of him. In fact, he got the sinking suspicion that one wasn’t even wanted. This doctor was making Ms. Goodwin look like a shrinking violet.
“I abide by the board’s decisions, even when I do not agree with them. I know my place,” Dr. Dunst continued with a hard look at Will. “Given the scarcity of information in your file, I am hesitant to assume you have the same, necessary mindset.”
Will blinked quickly, and leaned forward intently. “I assure you, my intent is to be a team player.”
His quick promise seemed only to make her more skeptical. “Your words are quite meaningless,” she said blandly. “As I said, the information in your file is scant. The glowing reviews from Dr. Goshit are notwithstanding. The file only encapsulates a small segment of your career. Where were you before joining us here?”
“Uh, Chicago,” Will said. “At Chicago Med.”
That kind of name drop usually held some weight, but not for Dr. Dunst. “For how long?”
“Just under 10 years,” Will said. He sat back, trying not to show just how uncomfortable this was starting to make him.
“Ten years,” she repeated. “Therefore, you would have been an attending? In a large city of decent repute--”
“I’m really not sure--”
She looked increasingly bored with the back and forth. “You abandoned your career at a critical juncture,” she said. “Moreover, you came here, which by all accounts is a step back in your forward trajectory. That suggests that you are incapable of making a commitment or were insufficient in your performance.”
Will’s jaw worked hard, and he felt his heart flutter a little. It was unsettling how correct her assessment was. “Or,” he posited in desperation, “I was just hoping to make a difference.”
She scoffed lightly, as though he’d told her a joke. “Pure altruism is uncommon in this world,” she said. “And it is no matter. You are here, and I am to make the best of it.”
Will took that as an opening. He sat up again, attempting to forge a smile. “Well, I assure you, I am ready and willing to serve--”
The unimpressed look on her face quickly took the wind out of his sails. She held up her hand. “Please, spare the theatrics, Dr. Halstead,” she said. “You are here, and I have no choice but to accept that. But do not confuse my acceptance with my approval -- much less my trust. You got this post because my superiors believe you have earned it.”
“Well, I have been fully committed--”
She shook her head again, cutting him off unceremoniously. “Do not assume to finish my thoughts,” she said. “They think you earned it. I follow their orders because that is my place, but do not conflate their trust with mine. If you work here, you will work hard, and you will follow my orders without question or delay. If you do not comply, I will not hesitate to transfer you.”
It was a cold delineation, and Will realized that this Africa fallback plan wasn’t foolproof. Four months of progress was just four months of progress. Will had pulled off four months before. Four months with his best friend. That was easy.
The long haul, that was the difference. Flourishing under conflict, that was the test.
If anything, her doubt was deserved. Her mistrust was with reason.
Stiffly, he nodded his head, keeping his eye contact steady. “Understood.”
Across from him, Dr. Dunst narrowed her eyes. She rocked back in her chair for a moment, lacing her fingers together thoughtfully. “See, I hear you say that, but I do not think you truly mean it,” she said. “This hospital -- my hospital -- is the best in the country, and we only achieve that through discipline and hard work. You will do more cutting edge work here, that is true, but there is zero room for error.”
“I understand high standards, I really do,” Will said. “But medicine isn’t an exact science.”
“That is a cliche doctors say to comfort themselves,” Dr. Dunst said. “Operating a hospital must be an exact science if it is to succeed. I will not let you compromise any element of what I am doing here. Do you understand?”
There were no shortcuts here. There were no shortcuts in redemption, then.
Will had to put in the work.
No matter what.
“Yes,” he said. “I understand.”
She gave him another long, appraising look. Though she still seemed to find him wanting, she finally inclined her head. “Very well,” she said. Then she picked up her pen again, turning back to her papers. “Now, go.”
With no other options, Will went.
He’d had Adam’s trust even when he probably didn’t deserve it, but he was starting from scratch with Dr. Dunst. It was time, then, to sink or swim.
-o-
Will wasn’t sure he was swimming, but after his first few days on the job, he was pretty sure he wasn’t sinking at the very least.
He spent his time at home studying the policy manuals, and he took pains to research every part of the hospital’s operation. He had memorized the name of everyone on staff, and he had a broad understanding of his daily duties, weekly duties and monthly commitments. He started to make a meticulous schedule for himself, mapping out point by point his daily commitment, accounting for time with patients, staffing issues, paperwork and financials.
On his first day, he introduced himself to the ED staff, and he scheduled a litany of one-on-ones to get to know each member of the nursing and doctor staff. With the techs, he didn’t have time to pull each one into an office meeting, but he made a point to meet and greet each one individually, just so he knew who was going in and out of his ED.
He had to build new connections, and he had to get a brand new lay of the land. In many ways, it was likely starting from square one again -- or worse. Adam had provided him a layer of support he’d taken for granted. There was no one to ask questions of now; there was no one to back him up. Will had to make his own decisions, and he had to stand by himself by those consequences.
The good news was this hospital was far more functional than the one Adam had run. With more funds and more staff, operations ran much more smoothly. Will didn’t have to reinvent the wheel here. He just had to make sure it kept spinning well.
This had a lot to do with the city. Adam’s hospital had been located in a poor section of town -- more or less, the slums. This hospital had a far more robust neighborhood, and that was evident in the number of patients who could pay their bills. As a result, the work hours were steadier, and there were more comfortable perks. The cafeteria food was actually tasty. The staff room was actually private. And Will had an office with an actual view.
Dr. Dunst, however, seemed intent to not let him -- or anyone else -- be comfortable.
Adam had run things his own way, and Dr. Salvo had been something of a non-entity. Back at Med, Ms. Goodwin had always had her say in things, but she’d granted a good amount of latitude to her employees -- a fact that Will had needlessly abused.
Such abuse wasn’t possible here. Dr. Dunst tolerated no latitude. Her morning briefings were always policy reviews, and her criticisms often stemmed from minor infractions. She said she was going to go easy on Will since he was new, but Will wasn’t sure what that meant. In two weeks, she offered not a single piece of positive feedback. Instead, he received harsh critiques and critical assessments.
And to think, he was making an effort to stick to the script this time.
Except sticking to the script wasn’t enough.
He needed to memorize the script.
He had to internalize it.
The script had to be second nature -- it had to be a part of him.
It was pretty clear that this placement, in all its posh comfort and cutting edge perks, was definitely going to be his hardest one yet.
-o-
Then, after nothing but sparse interactions with his new boss, she called him out of nowhere. The day was almost over, and Will had been diligently finishing his paperwork for the next day. When he saw Dr. Dunst’s extension on his phone, his stomach churned uncomfortably.
What policy had he let lapse?
Which protocol had not been followed?
Was it the extra acquisition order he had placed for more gowns? Had he been presumptuous to allow one of the nurses to switch shifts at the last minute? It had been a family emergency, and the gowns had been soiled by water damage from a leak that occurred before Will arrived, but still. Strictly speaking, there was room for criticism, and Will couldn’t prevent flashbacks to Ms. Goodwin’s office that fateful day nearly six months ago.
Maybe they had finally figured out that hiring Will was a mistake. It would always be a mistake.
The line was still ringing, and Will swallowed hard against the nausea. Whatever the consequences, he had resolved to face them. No matter what.
With that in mind, he took a breath and answered.
“Hello?”
Dr. Dunst was not one for small talk. In the two weeks Will had known her, every interaction had been one with an overwhelming economy of words.
“Dr. Halstead,” she chirped expectantly, not bothering to return the greeting or confirm her identity. “I know that you are about to finish your shift in the ED, but you are going to be required to work the night shift upstairs in the ICU. Our attending has come down with a case of the flu, and three others were already traveling for a critical care conference out of the province. As you should know, protocol demands--”
“--for another doctor of equal or greater rank to fill in,” Will said, finishing that section of policy code for her. “If someone in the discipline is unavailable, the closest option should be considered.”
“Yes,” she said, only sounding surprised for the barest of seconds. “The ICU and the ED are not perfect fits, but given your lack of seniority among the senior staff, I am obligated to inform you that the task does fall to you for this evening. I will assume that that is acceptable?”
The question was one that had only one answer, and Will wasn’t about to pretend otherwise. “Of course,” he said quickly. “I just have to finish up my paperwork from the ED shift, and I’ll be right up.”
There was a small sound of her breathing on the other end, and then she added, “You are new to this hospital, and you have no background in ICU care. I understand that this does put you out of your element, and I have some sympathy for that. If there are any critical issues you feel uncertain about during the shift, you are free to call me directly without any negative reflection on your performance.”
Will sat back, a little stunned by the offer. It wasn’t overtly demonstrative, but Will could read between the lines. She was offering to play backup.
It was an offer of kindness, actually.
“Thank you,” he said, remembering to speak. “I’ll definitely keep you informed if something unexpected pops up.”
He could almost see her brusque nod, even over the phone. “Very well,” she said. “Good night, Dr. Halstead.”
Rocking back in his chair, Will had to think that his good night was just starting.
-o-
Although he’d only been on the job officially for two weeks, Will had taken great pains to know every inch of the hospital and the personnel in every ward. That wasn’t to say he was on a first name basis with everyone, but he’d made a lot of progress. At the very least, he wasn’t a stranger to the people up in ICU -- and they weren’t unknown faces to him, either.
Such familiarity had been a matter of course as he tried to prove he could hold his own under Dr. Dunst. But it also yielded very practical dividends on the job. It always helped to have a good rapport with other departments -- doctors didn’t provide the best care to patients when they practiced medicine in a silo. Plus, when you needed to squeeze someone up into an overbooked ICU, it helped to have some favors to play.
And, when you had to pinch hit, at least you knew that the people there would have your back -- probably.
He knew that Dr. Dunst had offered her support, which had been a nice gesture, but Will didn’t intend to take her up on it. No, he’d been called into play, and it was his goal to step up. If this was a challenge, he intended to meet it. Dr. Dunst wasn’t impressed by just getting the job done. He wasn’t sure what he needed to do to impress her, but he was pretty sure that calling her in wouldn’t probably get him there.
Of course, doing the job poorly would also be counterproductive, so Will was going to have to do everything exceptionally -- and by himself.
While adhering to the strictest rules he’d ever worked with.
No problem.
As a department head, Will was well aware that he didn’t have the luxury of trepidation -- which was ironic, really. He’d spent most of his career mired in overconfidence. Now that he had the common sense to second guess himself, it wasn’t something he could afford to indulge.
Therefore, Will did the only thing he could do. He finished his paperwork and went upstairs, checking in with the ICU charge nurse and personally greeting the other attendings and residents on duty that night. Given his fast-tracked knowledge of hospital operation and his general expertise as a emergency room physician, he wasn’t totally out of his depth here. But he didn’t want to be presumptuous.
Instead, he monitored patient care with a keen observance of all protocol, and he focused on being the best doctor he could while supporting the more experienced ICU staff already in place. When things felt overwhelming, he reminded himself why he’d become a doctor in the first place. If he was here to save lives, then that was what he was going to do. Save lives, one at a time. In its purest form, medicine was beautifully simple, and that had always been where Will thrived.
Unfortunately, real world medicine did not always exist in its purest form. In practical application, medicine was rarely beautiful or simple. That was how Will had gotten here in the first place. Will had to practice medicine in expected boundaries and exterior expectations. He had done his best to balance those things, but it never got easier.
Six months in Africa, and he still had no idea what he was doing.
So, when the alarm sounded for a code on a patient in bed 3, Will was up. He knew how to run a code, of course, and a cursory glance at the patient’s file gave him sufficient background to provide the necessary treatment. 46 year old female, two days post op. She had completed an intricate back surgery, which had left her spine precarious as it healed. Complete immobilization had been required, but now all indications were that she had thrown a pulmonary embolism.
First, Will restored the heartbeat, supplementing with manual ventilation. He added an order for collodion thinners as they moved in the scanner to visualize the chest for size and placement of the clot.
He was just confirming the clot when the surgical resident came in, having been in on the initial procedure. When the resident saw what Will was doing, he looked mortified.
“She’s on strict mobilization,” the resident protested.
“She also crashed,” Will said, adding a note to the file. “The rules of triage would apply.”
“Normally, yes,” the resident said, sounding nearly beside himself now. “But this patient, do you know who she is?”
It felt like a trick question. Will knew who the patient was from her chart, but clearly, there was some context he was missing here.
“Ariana Mu?” the resident asked, his eyes nearly bugging. “Academic elite, wealthy family with massive donation ties to this exact hospital--”
“Okay,” Will said. “All the more reason we should help her now.”
The resident scoffed. “We need to back up here--”
The notion was quickly put on hold when the monitors sounded again. “Damn it,” Will said. “She’s crashing--”
He got himself in position to start chest compressions once more while the nurse obediently continued ventilations.
“You can’t do that!” the resident objected loudly.
“Someone get the epi on board,” Will said to the nurses. He shook his head at the resident. “Why not?”
“I have worked with her since her admission,” the resident said. “She has expressed to me repeatedly that she does not want to suffer any deficits.”
Will continued the rapid rounds of pressure while the nurse injected the meds into the IV and the monitors continued to chirp. “So?”
“So?” the resident said. He pointed at Will. “What you are doing -- it could paralyze her!”
“I know that,” Will said. “But I read her file. She doesn’t have a DNR.”
“Well, no--”
Will reached for the paddles. “Let’s start at 150 -- clear!” he said, shocking Ariana. He glanced at the resident. “In your background, did she object to any specific measures?”
“No--”
“No response,” the nurse reported.
Will made a face. “Give me 200,” he said, quickly shocking her again. “And she understood the risks?”
“Of course,” the resident said. “But if we paralyze her--”
“Still nothing,” the nurse reported.
Will started doing compressions again, feeling the pressure start to build. “Our objective is to keep her alive,” he said. “If there’s no DNR, then I’m finishing this code.”
The resident shook his head abjectly. “But Dr. Halstead--”
“Another miligram of epi, please,” Will said. Then, to the resident, he continued. “I understand your desire to follow the patient’s wishes -- I really do -- but we have to respect their actual wishes and not our interpretation of those wishes. She knew the procedure and its risk, and she didn’t sign a DNR.”
The resident backed up a step. “I can have no part in this.”
“Fine,” Will said, reaching for the paddles again. “Then I’ll take full responsibility. Let’s go to 200 -- clear!”
The resident was already out of the room, when Will finished, and this time, the nurse smiled. “Sinus rhythm.”
“Good,” Will said. “Now, we’re going to have to get her up to the cath lab immediately -- try to bust this clot before it moves to her brain and we’ve got serious issues. I’ll call down, but you get her prepped to move.”
The nurses acknowledged his orders, and Will started out to the desk to make the call and update the chart. To his surprise, he found the resident coming back down the hall, nipping at the heels of Dr. Dunst.
Dr. Dunst didn’t look pleased, but she was the kind of person who never looked particularly pleased. The resident was talking to her in an animated fashion -- it wasn’t hard to figure out his topic -- and Dr. Dunst listened to her jaw tight and her eyes ahead.
Will felt a momentarily pang of trepidation, but there was nothing to be done for it now -- any of it. He didn’t bother with pretense, keeping his feet planted as she approached.
“Dr. Halstead,” she said. “Dr. Remay is quite concerned about your treatment plan for Ariana Mu. Can you please tell me what occurred?”
“Sure,” Will said. “Ms. Mu had been recovering, two days post op. Her SATs were less stable this evening before I was on duty. She was not my patient, but when she coded, I was the doctor available. I reviewed her chart, and then followed code protocol.”
It was an answer that was direct and to the point. He had no other defense, and he wasn’t interested in justifying himself.
Dr. Dunst, at least, seemed to appreciate that approach. “As would be expected,” she said. She turned to the resident. “And you have concerns about Dr. Halstead’s clear actions here?”
“Yes,” the resident said. “I have worked with Ms. Mu for some time now. She’s one of our biggest donors, and an intellectual elite. She repeated has expressed how important it is for her to stay without deficit, and Dr. Halstead’s actions put her at risk for paralysis.”
“As is necessary to run a proper code,” Dr. Dunst said. Her forehead furrowed as she studied the resident. “Did Dr. Mu have a DNR? Were there any special notes regarding her resistance to certain procedures or interventions?”
The resident flattened his lips. “No.”
Dr. Dunst frowned now, shaking her head. “Then, tell me. What would you have Dr. Halstead do?”
“Consider the patient’s wishes!” the resident insisted. “He comes in without any background -- he’s not even a member of the ICU staff.”
Will felt his cheeks redden, but Dr. Dunst was plaintive in her reply. “The patient’s wishes were made clear in the file,” she said. “According to protocol, all measures should be used unless the patient specifically objects. I assume you discussed the risks of the initial procedure with her?”
The resident went a little wide eyed. “Of course.”
“Then, I fail to see the problem here,” Dr. Dunst. “This is a procedural question that has a clear delineation of cause and effect.”
The resident scoffed with the self effacing confidence that Will remembered. “Ms. Mu is our biggest donor,” the resident said again, voice punctuated with frustration. “And she’s brilliant.”
“And she’s still a patient,” Dr. Dunst said with a dismissive shake of her head. “Dr. Halstead operated in this case exactly as I would, and frankly, you are lucky he was here. Your lack of action and hand-wringing would have killed her.”
The resident’s mouth dropped open, and his face burned red. He looked to be on the verge of arguing, but Dr. Dunst was clearly unswayed.
“That is all,” she said curtly. “You still have patients to attend, do you not? I suggest you go make yourself busy before I seriously consider a deeper review of this case, a review which I am quite confident would not go in your favor.”
Mouth snapping shut, the resident turned hard and fumed down the hall. Will watched him, somehow both amused and sympathetic. He’d been there. Hell, that was what had gotten him here.
Dr. Dunst drew a breath, and she looked at Will. “Where are we at, then?”
“Just transferring Ms. Mu down to the cath lab,” Will said. “I’m optimistic we can get the clot there before it causes any more problems.”
She nodded with disinterested approval. “And you are confident in your choices here? Or is a deeper inquiry still warranted?”
It was an interesting question, one that posed a semblance of skepticism and a good dose of trust. He wasn’t young and brash anymore, and the mere idea of overconfidence could be enough to derail him sometimes. But Will had read the file. And he knew the protocol.
He had played this one right down the line.
So, he shook his head. “I followed protocol completely,” he said. “There was no other way to play this one.”
“Very well,” she said. She nodded, pursing her lips with her eyes set in a facsimile of a glare. Yet, somehow, she continued, “Good work, Dr. Halstead.”
He didn’t know what to say. Dumbly, he just stared at her.
She shrugged, as if uncomfortable with the silence. “Anyway,” she said. “I trust you have things well in hand? I will leave you to it.”
And Will could only watch her go, wondering if this was what success felt like after all this time.
-o-
The good news was that Ms. Mu’s procedure in the cath lab was successful. The better news was that by morning, she was awake and cognitively intact by morning. She could also still move her extremities, and repeat scans suggested that there was no sign of damage to her spinal cord.
As he was wrapping up to finally go home, the resident in question came to him. It was funny to Will how young he looked, and it occurred to him that he wasn’t a bad doctor. He was dutiful and conscientious, and he cared about his patients -- probably more than he should. He’d been wrong, overall, but in the moment, from his perspective, it made more sense that Will had been willing to grant him.
Doctors didn’t need to learn to care less. They needed to learn to care within boundaries. Arrogance wasn’t thinking you could do everything. It was thinking you always knew best.
And it was so, so easy to do.
You felt it with every beat of your heart, every voice of reason in your head.
The line between being a good doctor and a terrible one was much thinner than people realized.
Much thinner than Will had allowed himself to consider until now.
With a steadying breath, the resident looked at him. “You didn’t tell her what I did.”
Will returned his statement quizzically. “You didn’t do anything. I was the doctor on call for that code.”
But the resident was already shaking his head. “I tried to stop you. I jeopardized her care, and I just went in there, and she thanked me for saving her life.”
“And?” Will said. “Weren’t you in on the surgery?”
“Yes,” the resident said. “But we both know I would have killed her.”
“We don’t know that,” Will said. “You were expressing doubt, not making the executive call. It’s different when you realize that the buck stops with you.”
“No, no way,” the resident said. “You’re giving me an easy out, and I don’t deserve it.”
“Well, if you’re giving yourself a hard time, then what do you need it from me for?” Will asked with a pedantic shrug.
The resident scoffed, still shaking his head. “I don’t get it.”
“I know,” Will said. “I didn’t either. Which is why I’m not the one to call you on it. Dr. Dunst, on the other hand, might. So I’d watch yourself for awhile, just to be sure.”
He was willing to leave that as good enough, but the resident looked him down one more time. “How did you get on her good side?”
Will stopped short, this time genuinely surprised. “What?”
“How did you get on Dr. Dunst’s good side?” he asked. “She literally scares the crap out of everyone, but she was positively glowing to you last night.”
Positively glowing was a funny description for such disinterested behavior, but in the few short weeks he’d known her, he couldn’t pretend like the assessment was entirely off. He just hadn’t noticed. He hadn’t let himself notice.
And this kid was just a resident.
Will shook his head. “I was just doing my job,” he said, setting off to leave now. He looked back one more time. “Just like you need to keep doing yours.”
-o-
Will couldn’t pretend like he didn’t like to have his ego stroked -- of course he did, and of course that had been one of his flaws as a doctor and as a person. He could be too confident -- and that could make him cocky. Simply put, his overestimation of his own worth had always been an obstacle to real success.
Therefore, he didn’t take Dr. Dunst’s approval as a validation.
No, he took it as a challenge.
It showed that she wasn’t an impenetrable wall of self control and medical policy. Dr. Dunst could be impressed. Dr. Dunst could be ingratiated. Dr. Dunst might actually come to respect him someday.
That required even more work, even more dedication -- even more everything. Will had to master every part of medicine, from patient care to staff management and beyond. His hours? Had to be longer. His patient outcomes? Had to be better. His budget gains? Had to be palpable.
Because he knew that Dr. Dunst was impressed by flashy saves, but earning her trust was more than that. There were plenty of talented doctors in the world, but Dr. Dunst was looking for something else. Something more.
A doctor was just one part of the system, after all. Will had never fully appreciated that. Sure, he’d leveraged it when he needed to, but it couldn’t be a system of convenience. In order to really operate at the highest level, each part had to be cognizant of the rest.
Will didn’t need to be a better doctor.
He just needed to understand the system more.
He had always worked the system, but now he had to work for it.
It was the right thing to do, he decided.
And maybe -- just maybe -- he might finally show Dr. Dunst that he was worth something after all.
-o-
Hard work was hard work, nothing more. It wasn’t fancy; it wasn’t flashy. It was just blood, sweat and tears.
And hours.
Will was the first one there in the morning. He clocked in before his shift, and he had his charts done before anyone else had started. He worked through his lunch, and he was always available for a consult, a second opinion or a crisis of conscience. He was a shoulder to cry on. He was a voice of reason. He was the leader in every possible way. When the rest of the day shift clocked out, he was still there. He was the last one to leave, so much so that the night shift knew him by name as well.
It wasn’t clear that any of this made an impression on Dr. Dunst. In fact, there was no indication that she’d noticed his hard work at all. Every time they interacted, she was professional but cold, and she never offered him the faintest of praise. Her preference seemed to be to rarely deal with him at all, and she always had a litany of questions to assess his professional choices without any personable chitchat.
Clearly, Dr. Dunst was going to be a hard sell. Or, possibly, an impossible sell. Will found that a little discouraging, but there was no recourse for it. To let up now would only validate her doubts about him, and there was no way he wanted to make his position even more tenuous than it already felt.
However, everyone else was starting to take note.
It didn’t take long for the attending to open up to him. He developed a quick rapport with all of them, and that sense of camaraderie worked its way down the whole staff. Within several weeks of his arrival, he saw dramatic improvements in the overall functionality of his department. Work was done faster; patients were treated with more efficiency.
And not just the practical things. There were other changes that were harder to quantify. Staff members seemed happier. Their diagnostic skills quickly excelled. They weren’t just treating more patients. They were treating patients better.
The ED also enjoyed a newfound give and take with the rest of the hospital. Cultivating a relationship between multiple departments was no easy task. Even at Med, it had been an imperfect process. But Will made time to touch base with every department head in the hospital, and soon he was on a first name basis with each and every one. It took a little longer to learn all the residents’ names, but one month into his tenure, and he had established himself as a key network player between himself and every other department in the hospital.
The cost on his personal life, of course, was palpable. In other words, he didn’t really have much of a personal life anymore. For as nice as his apartment was, he rarely spent time in it. It was a home base for showering and eating, but little more than that. His breakneck pace was tiring, to say the least, and there were moments when he thought he couldn't keep it up.
Quitting wasn’t a privilege he had anymore, though.
It didn’t matter if he was tired.
It didn’t matter if he was lonely.
Will had a job to do.
-o-
When Will had started at Adam’s hospital a few months ago, the goal had been to serve a very underprivileged part of the community. The organization specifically targeted these areas to bring up the standard of care. It was hard work, with very little profit. It also tended to be quite thankless, but Will had taken that for what it was.
Dr. Dunst’s hospital, by contrast, was the exemplar. This hospital was the endgame for the organization, starting off small and poor and building a reputation large enough to attract donors and big name patients.
A destination hospital, as it were.
That had never been Will’s thing, necessarily. Sure, a little attention felt good now and again, but he was wary of it all by now. He had come to Africa to get away from his own impossible ego. He’d been trying to disappear.
Trying and succeeding -- a little too much apparently.
Because one day at work, a VIP patient came into the ED and requested Will by name.
During his short tenure at the hospital, VIP patients had become something of an ubiquitous reality. He’d encountered them before, mostly at Med and in New York. Of course, in those contexts, usually the VIPs were assigned to more important doctors -- and that had never bothered Will. Growing up in Canaryville, he’d come at things with a bit of an inferiority complex. It wasn’t hard to tell when he was overcompensating.
That said, now that he was Chief of the ED, the VIPs were his business -- almost to the point of absurdity. Because if Dr. Dunst loved her protocol, she valued her VIPs more.
And now that Will was in charge of the budget for the ED, it wasn’t hard to see why.
One VIP patient could fund his department for a month. More than that, it had something of a domino effect. One VIP patient could lead to two VIP patients. As the connections grew, so did the hospital’s notoriety. That was why, despite all commitments to equal care, Will dropped all his paperwork to go take Mr. Alawe’s treatment into hand himself.
Mr. Alawe was clearly in his late 50s, but he seemed to want to appear younger. He was wearing high end workout clothes, the kind that wealthy men wore to make it look like they were still average people who could actually sweat. Although he didn’t seem to be in any particular distress, his foot was propped up on the bed and copiously swathed in ace bandages and ice packs.
“Mr. Alawe,” Will said, coming in and offering his hand with a broad smile. “I understand you hurt your ankle today.”
Mr. Alawe smiled brilliantly. “Yes, I am afraid it is true!” he said with impeccable English. “I was playing racquetball, but I am not quite as nimble as I used to be.”
“It happens to the best of us,” Will said, turning his attention to the damaged appendage. One of the residents had already completed the history and the background, and Will confirmed that the orders had appropriately asked for the right tests. The x-ray was already on file. “All part of the price we pay to stay healthy.”
Mr. Alawe laughed roundly. “Or the price we pay for getting old!” he said jovially. “But it is not so bad.”
Will started to unwind the bandages, setting the ice aside for a better look. “Your pain is better?”
“No, no,” Mr. Alawe said quickly. “I just meant that it is fortuitous. I had heard there was a new ED Chief, but I had not met him yet to find out for myself. Then, just like that, I hurt my ankle! Surely, it is fate for us to meet today!”
Will smiled politely, looking at the x-ray that had been produced. “I’m not sure I’d call it fate, but at least it’s not broken,” he said, turning back to the foot in question. He palpated it once more. “You still have good range of movement, so I have no reason to suspect that there’s any kind of ligament damage. Probably just bruising to the muscle.”
Mr. Alawe, for all that he’d come in for, didn’t seem remotely interested in Will’s diagnosis. “Most of the doctors here are quite active in the social scene,” he continued. He gave Will a curious look. “And I know all of the other department heads by name! Dr. Dawson comes to my weekly poker game -- no money exchanged, I swear! It is just for fun. And dear Dr. Lorio is quite the golfer!”
“I’m sure she is,” Will said reasonably. He reached for some fresh medical wrap. “I’m going to go ahead and wrap your ankle, and we’ll give you something to help you get around while staying off your feet. We won’t need anything as dramatic as a boot, but I can get PT in here to fit you with a stabilizing brace until your ankle is healed.”
Mr. Alawe was hardly listening. “Oh, and the hilarious Dr. Ngo! He is an avid patron of the arts! I had him over for the opening of an exhibit at the gallery just two weeks prior!”
“Well, it sounds like you are a staunch supporter of this hospital, which is wonderful,” Will said, starting to wrap the exposed ankle. “Are you feeling any discomfort?”
“No, no,” Mr. Alawe said. He bit his lip and tipped his head to the side. “And what about you, my dear Dr. Halstead? What are you interested in?”
“Me?” Will asked, He glanced at the man in a bit of surprise as he finished the wrap. “I’m just here to do work, Mr. Alawe. That’s all.”
“That is an admirable work ethic, it is!” Mr. Alawe resounded. “But you are a smart man, yes? You know that life is more than work.”
“I’m still new here,” Will admitted, securing the wrap now. “So I’m working on finding that work-life balance.”
Mr. Alawe winked at him with a conspiratorial air. “You are still young, yes? Young enough. And that red hair must make you quite popular.”
Will chuckled. “It does tend to stand out.”
“I just would like to know you better,” Mr. Alawe said. “I am always looking for new ways to get involved. I have too much time, too much money. It can make you lazy, it can make you stupid. I like to invest in good causes, good people--”
“I’m really not sure what you mean, Mr. Alawe,” Will said as deferentially as he could.
Mr. Alawe narrowed his eyes, the injured ankle all but forgotten. Will had been striving to provide idealized care, but Mr. Alawe seemed to have other goals in mind.
“Here,” he said, reaching into his pocket. He pulled out a business card, turning it over. Producing a pen from his pocket, he scrawled something on the back, and then he held it out to Will. “This is my card. My work number is on the front, and that is fine, because I have a very good personal assistant, but -- the number on the back! That is my private number! I will answer that one myself! Guaranteed!”
Will was reluctant to accept it, quickly going over in his mind the policy on personal interactions with patients. A phone number didn’t count as a gift, therefore Will wasn’t beholden. However, the exchange of a private number could indicate preferential treatment, which was prohibited.
That said, Mr. Alawe was holding out the card, and he knew the kind of sway patients of this caliber held.
Will accepted the card, bobbing his head forward. “Well, thank you. And, you know, if you ever end up in the ED again--”
“I will look you up!” Mr Alawe said, beaming proudly as Will pocketed the card. “Although, something does occur to me.”
Will perked up. “Do you have other symptoms you need to discuss?”
“No, no,” Mr. Alawe said. “But I am having a party in a few weeks.”
“Oh, well, your ankle should be fine by then.”
Mr. Alawe shook his head. “No, I am not thinking of my ankle,” he said. “But the guest list. Such things -- they are tedious -- but important! A good party must have the right guest list!”
Will wasn’t sure what that had to do with him, but if small talk was all that was required to make Mr. Alawe’s stay better, then he could spare a few minutes. “I’m sure a man like you always gets the best.”
“Oh, I do, I do!” Mr. Alawe agreed with enthusiasm. “But this one, you understand. This one is special.”
Will had no idea what that actually meant, and he momentarily wondered if this was just the kind of thing that was expected to be a topic of conversation when you reached a VIP status. He’d only been an ED Chief for about a month now, so the idea that he knew what he was doing was laughable. He was badly out of his depth here, and he knew it. Unlike most things, he couldn’t protocol his way out of this conversation.
He just had to try to be polite and hope that he picked up on enough social cues not to alienate one of the richest men in the city.
And, with all that, the only reply he could come up with was: “Oh?”
By making it a question, he hoped to imply that he was interested and not just completely confused. His efforts interacting with rich and powerful people was limited, and the last time he’d made an attempt, he’d ended up brokering a contract for a murderer and working as a CI.
So, you know, good memories.
“Oh, a little thing I host each year,” he said, flitting his hand through the air, even as he narrowed a keen gaze on Will. “Many hospital staff come, people from around the city -- the province. You know, the best of the best.”
Will wasn’t entirely sure what was being insinuated here, but the phone number on the back of the card and the casual indication of a party seemed to suggest that Will could be on the invite list.
That was ridiculous, of course.
Except Mr. Alawe was watching him -- almost hopefully.
Will laughed, backtracking almost immediately. “Well, I’m very busy, Mr. Alawe. Still getting my feet wet, so to speak.”
“All the more reason to get take, get your bearings, make connections,” Mr. Alawe said. “It is practically a conference for the medical elite!”
Will wasn’t sure how that applied to him, but he blushed appropriately anyway. “As I said, Mr. Alawe, the offer is generous, but my schedule just doesn’t allow for it.”
This wasn’t the kind of man who took no for an answer, however. He nodded, smiling like he knew something Will did not. “Just think on it. Talk to your boss. Maybe the good Dr. Dunst will give you the night off?”
“Oh, do you know Dr. Dunst?” Will asked, grateful for something else to discuss.
Mr. Alawe took his turn to laugh. “She must be a very competent doctor because she is not a very sociable person,” he said in a low voice. “But seriously. Think on it! Next Friday! If you want to be added to the invite list, all you must do is call that number, yes? Call!”
Will patted his pocket where the card was. “Well, I’ll consider it,” he said, mostly as a matter of being polite. He got up, reaching for the hand sanitizer on his way out. He turned back to smile one more time. “Good luck, Mr. Alawe. And if you experience any problems with that ankle--”
Mr. Alawe held up his finger eagerly. “I’ll know just who to call!”