Chicago Med fic: Mercy (3/10)
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
The next patient on the queue is Edwin Garside.
He’s brought in via ambulance, and he makes a big show about it being unnecessary. He’s shot himself in the foot with a nail gun, you see, and he lives by himself. He’s in a little pain, but he feels pretty good otherwise, but he didn’t want to cause a car accident by pushing on the accelerator too hard and inadvertently passing out.
Will assures him he made the right call, and starts to take the man’s history, having him detail the event, recording his vitals and noting any significant medical history. It’s all very by the book and professional.
Also in the room is Emily, and she is the only nurse assigned to the case as the case is considered non-emergent and the ED is already stacked with patients. While Will takes the professional route, Emily fluffs a pillow for him and starts asking him a series of personal questions.
Will learns he’s got a history of heart problems that have been well controlled for the past 20 years.
Emily learns that he’s going through a moderately contentious divorce and that remodeling his apartment was a whim he undertook while in a midlife crisis.
Will listens as sympathetically as he can while he continues his assessment -- unwrapping the bandage from the paramedics, checking reflexes and confirming his fluids and medications -- before he sees his opening to get this back on track.
“So, tell me more about your heart,” Will says, interjecting while Emily is talking to him about his daughter. “What was the diagnosis?”
Mr. Garside is imminently amenable, and he readily comes back to Will’s point. “Oh, there was some sign of disease back in my 30s, really early onset stuff that they were concerned about,” he explains. “I got referred to a cardiologist straight away to hammer out things like my blood pressure, cholesterol -- you know.”
Will tries not to frown, but he takes this note with due interests. Mr. Garside acts like it’s nothing, but Will’s an ED doc. He doesn’t mess around with heart conditions. “And how’s that been going?”
“Good, I think,” Mr. Garside says. He shrugs. “I mean, it lit a fire under my butt. I got my act together, changed my lifestyle. Health food, exercise, meds -- all of it. The cardiologist says I’m his model patient now, and everything else has been smooth sailing.”
Will smiles at him. “That’s great,” he says. “Have you experienced any chest pains this morning?”
“No,” Mr. Garside says. He turns his smile to Emily now. “Just this nail in my foot.”
She smiles back, a hand on his arm. “And it sounds like you’ve got plenty of other things to worry about.”
“No kidding,” Mr. Garside says, even while Will goes back to probing his foot. “I thought getting my health together would fix things, you know. Stabilize my career. Bring my family together. But the opposite has happened. It’s all just been falling apart. I thought doing woodworking would help me decompress or whatever, but here I am.”
He gestures to himself with some self flagellation.
“Can you move your toes for me, Mr. Garside?” Will asks, trying to better gauge if any tendons have been involved.
Mr. Garside complies.
“Good,” Will says. He feels along the bottom of his foot. “Can you feel this?”
“I can,” he says with a small grimace. “Kind of wish I couldn't.”
“I know,” Will says apologetically. “And once I make sure you’ve got sensation intact, I promise, we’ll give you something to take the edge off.”
“Too bad the bad the rest of life isn’t that easy,” Emily says, laying a hand on his arm reassuringly. “A shot and all our troubles go away.”
Mr. Garside smiles back at her, but Will doesn’t have time for this rabbit hole. The patient’s backstory has relevance, sure. But the most pressing problem is the hole in his foot, and Will needs them all to focus if he’s going to alleviate the pain his patient is in and reduce the risk of infection.
Emily has perhaps taken his touchy-feely approach as tacit consent to continue on in this manner with patients. It’s her way, and Will knows that. But she seems overly invested, more distracted than usual.
“All the same,” Will interjects before Emily can pull away Mr. Garside’s attention entirely. “I assume you’d like to get this taken care of?”
The man nods up at him, grateful. “I would,” he says. “Do you think I’ll be out of here for dinner? I have plans with my daughter.”
“That’s wonderful,” Emily says. “How is she taking the divorce?”
“Not great, honestly,” Mr. Garside says, turning back to her with a sense of commiseration. “That’s why tonight is important to me. She’s taken her mother’s side a bit, I’m afraid. I need to prove to her that I’m still in her corner, no matter how much our lawyers yell at each other.”
“Well, if we get things moving here, I think we can make that happen,” he says, and he forces a smile as he tries to make eye contact with Emily and give her the necessary visual cue that it was time to move it along. She blinks at him benignly, but it’s like she doesn’t see him at all. Will inclines his head at her more purposefully. “Can we prepare Mr. Garside’s foot, please?”
There’s just the slightest edge in his voice, and by now, she knows him well enough to hear it. “Yes,” she says, bustling to her feet. She places her hand back on Mr. Garside’s arm with an encouraging smile. “Of course. You’d like that, right? To be done with this pain?”
The man chortles. “From your mouth to God’s ears, darling,” he drawls.
It’s a charming response, and Will knows immediately it’s going to drag Emily back in. Which is unfortunate. Sometimes, he can indulge her desire to spend time with patients. Today is not one of those days, not with patients lining up and Will’s leash as short as ever. He’s tried to be her friend, and he sort of wishes she could return the favor every now and then.
“We’ll be right back to get started,” Will tells him. He moves around the bed, placing a hand on Emily’s shoulder to get her attention. “I could use your help getting prepped.”
She looks up, and the protest is written all over her face.
But Will grits his teeth and stares back at her.
Uneasily, she lets go of Mr. Garside’s arm. “Of course, Dr. Halstead,” she says, and for about two seconds, she almost sounds like an actual nurse. She smiles back at their patient one last time as Will all but ushers her out the door. “Be back soon, Mr. Garside!”
They make it into the hall, and Will reminds himself. He’s trying to be Emily’s mentor. He needs to be her point person to find success at Med. He’s working to become her friend in an effort to get her acclimated to the culture here.
That’s the goal, and in theory, it doesn’t sound that hard.
But in practical application, Will is struggling.
Will is struggling a lot.
There can be no scene this time. He can’t raise his voice, lose his temper, or show emotion. He doesn’t need to ask her about her schooling or her hobbies. This is clear, simple, cut and dry. Even Emily can understand the basics of procedure when she has to.
The the love of all that is good and holy, he needs her to understand it just this once.
“Look, I know you have a great ability to connect with patients, and you are spectacular and getting them calm,” he says, because starting out with the positive is the best way to give constructive -- and desperate -- feedback.
She beams a little at him. “And I love that you notice.”
Because they’re all vain people in the end. Until your humility is stamped out of your by the consequences of every wrong choice you’ve ever made and you end up on probation as a nursing mentor.
Will seeks his resolve and finds it, but barely so. “But right now, we do need to move things along,” he says. “We are way backed up with patients, and Mr. Garside deserves to get about with his day.”
At this, the pleased look on her face evaporates. “He says that what he wants, but I’m really not sure,” she says. “He covers it well with an amiable disposition, but I think he’s an unhappy man. There’s a lot of hurt inside him.”
Will shakes his head. “Maybe, maybe not,” he says. “But he definitely has a lot of pain in his foot -- and he has dinner plans.”
Emily draws her lips together primly. “He’s scared to go, though,” she says. “To see his daughter. He’s afraid it won’t work.”
“Emily, the result of his dinner with his daughter -- that’s not really for us to control,” he says. “All I know is that he’s got a nail in his foot, and we’ve got to clean the wound and check for signs of damage. Then, we get him out of her so he can make that date and do as he pleases. It’s great to care about the patient’s life -- but we have to remember that the goal is to get them back to their lives as fast as possible.”
To this, her expression turns somewhat funny. “And if that’s not what’s best for them?”
He wrinkles his nose. “Emily, I know you like the moral debates, but we don’t have time,” he says. “Please, get his foot prepped so I can clean it, and we need to get in a script for antibiotics.”
“But he’s unhappy,” Emily says, unable to let this go. “Surely, you can hear it when you listen to him talk.”
“I am listening to him,” Will counters. “And I’m listening to his health story. He’s taking care of himself. And despite the things he’s got going on, he seems to be coping well. If you’re really concerned we can rope in Dr. Charles--”
At this suggestion, her face sours. “Psychiatry is too reductive. It starts with too many suppositions.”
He sighs, and shakes his head. “Emily, we have to treat the problem in front of us. Okay? You can chit chat with him while you do it. But I need it done, okay?”
She grows quiet for a moment, looking at him curiously. Then, finally, slowly, she nods. “Okay,” she agrees. “I completely understand, Dr. Halstead. Focus on the problem at hand. Fast solutions.”
“You got this?” he asks, eyebrows raised.
Her smile turns, sweet and simple around the edges. “I got this.”
-o-
It would be nice if for once, when Sharon Goodwin showed up at work, things were going well. She could have a fast, uncomplicated morning with no surprises or unpleasantries.
That would be nice, for sure.
It’s not particularly realistic.
Especially not for her understaffed hospital with budget constraints operating at overloaded capacity during a damn pandemic.
If it weren’t so stressful, the whole lot of it, it might actually be hilarious how everything that can go wrong does go wrong in her life. To think, she’s looking back on the years of her tumultuous divorce with fondness for how simple they were.
No matter. At least with so much on her plate, there’s no time to sit and thoroughly contemplate how stressed out she is.
Still, as it is, she’s drowning in budget paperwork, and she has to field an unexpected call from a donor that requires her full attention for a good twenty minutes that are not accounted for in her schedule. By the time she’s done, she’s almost forgotten than she has a standing meeting with the Chief of her ED.
Ethan, ever reliable, is waiting for her when she lets him in with an apology.
“We’ll try to keep this brief,” she says, leading him in to sit. She glances back as she moves around her desk. “Unless you have particular concerns.”
He makes a face while he sits, offering her a noncommittal shrug. “I don’t think so,” he says.
She wants to believe him, even if part of her suspects that’s just the kind of thing people say to their boss when they don’t want to tell them the truth.
Unfortunately, it’s also the kind of answer Sharon needs to hear on a day like today. “Good,” she says, settling herself down across from him. “I’ve seen the numbers, the budget report -- everything looks pretty good.”
This is the fast and easy way to look at things, and Sharon doesn’t always opt for the easy way out. But sometimes it is -- well, easier.
There’s just one other agenda item on her meeting with Ethan today. “And how’s the new nurse?” she asks, skimming the notes she’s jotted down in her planner. “Emily Novak?”
The hesitation in Ethan’s face is more pronounced this time, but he works equally hard to cover it. “It’s not been the most natural fit, honestly,” he says, and the admission suggests there’s a lot more to it than that. “But we’re working on getting her up to speed. She does seem very willing. Dedicated.”
Sharon cocks her head, taken aback by the description. Willing and dedicated are fine things to be, but they are not the core essentials of a Med ED nurse. “That’s not telling me much,” she comments, noting to herself that it probably tells her more than it should. The description says nothing of her nursing ability; it’s telling.
Ethan squirms in his seat because he knows it, too. “Honestly, I haven’t worked with her much.”
Now, this admission is even more telling, and at least Sharon doesn’t have to beat around the bush. “Oh?”
Ethan sits forward, still fidgeting in his seat. “I tried setting her up with a nursing mentor, but they’re all so overworked that it was a hard match to make,” he explains. “I talked to Maggie about it, and ultimately I’ve had Will Halstead take over most of her training and direction. He’s been working with her a lot the first few weeks, helping her get acclimated. Maggie agreed that having her mentor with a doctor would be the most streamlined approach, given our unique situation.”
Given that they don’t have a single nurse to spare. It’s the reason Emily had been considered an essential hire in the first place and Sharon had willfully overlooked the lack of professional references.
Yet, the solution isn’t as haphazard as one might think. “I can see that being a good thing,” she muses as she considers it. “For her -- and him. She could use someone with experience in the ED, and Dr. Halstead can always use someone to keep him accountable.”
Two birds, one stone. That kind of efficiency is hard to come by palatably in her line of work.
This does catch Ethan’s attention, however, and his guise breaks for a moment. “Will’s been doing fine,” he says, as though that should be self evident. “He’s been a huge help around the ED, in fact. I wouldn’t call this a punitive measure.”
Sharon lets her head dip to the side again. “Well, if Dr. Halstead is flourishing, then how is Emily faring?”
Sharon watches as Ethan rallies himself to come up with she supposes is a professionally detached kind of answer. “Well, with Will working with her in a supervisory role, I’ve been perfectly comfortable. It really has helped balance out the workflow for the rest of the ED.”
It’s a positive report, but a careful one. There are still things that Ethan Choi is not saying to her right now, but he’s got a pretty good track record. She trusts him to delineate the necessary details -- for both their sakes. “That works,” she says, matter of fact. “And if there’s nothing else?”
Ethan smiles politely and gets to his feet. “Then, I’ll get back to work.”
That makes two of them.
-o-
Sharon tries to let well enough alone. She has a positive report on hand, from one of her most reliable people in the hospital. There is no indication that anything is amiss for once. Everyone and everything seem to be in working order.
More than that, she doesn’t have time to worry. There’s no time to dwell. She can’t chase down her whims and fancies just for her own peace of mind. The ED is fine. She has to take the evidence at face value. Everything in the ED is 100 percent, absolutely just fine.
They’ve got a new nurse on the floor. Growing pains are normal, but it’s helping. There’s no reason to suspect it’s not working.
Before her lunch meeting, she checks her email. At first, Sharon braces herself when she sees an email from Gwen. To her surprise, however, the email is glowing.
Glad to see things in the ED are picking up. We may have to review your current ED budget. I think a few additional discretionary expenditures may be in order. Don’t you need a new x-ray machine? I’ll bring it up at the meeting tonight.
That’s a novelty, to be sure. Sharon takes it as incontrovertible evidence that she has nothing to worry about at all.
-o-
Comparatively, Will thinks today might actually turn out manageable. After his talk with Emily in the morning, she’s been more focused the rest of the day. He hasn’t had to start a single IV or load any of the meds himself. She’s being active and responsive, and Will thinks maybe -- just maybe -- they’ve turned a corner.
As a result, things are getting done, and for once, his workload is actually manageable. As soon as he can get Mr. Garside discharged, he’ll settle down to focus on his rounds, and he might be out of the ED on time for once.
Now, the case with Mr. Garside has been frustratingly long winded. While Emily has been on her game with other patients, for some reason, no progress seems to move ahead with Mr. Garside. Will has cleaned and treated the wound -- no sign of infection or tendon involvement -- and he’s got the medication order in hand. He’s fully ready to discharge the man, but Emily keeps bringing up points to slow things down.
She wants to test Mr. Garside’s range of motion. She wants to explain his medication regimen to him in more detail. Honestly, at a certain point, Will stops keeping track of the reasons, and now that the poor man has been stuck in the ED for most of the day, Will decides enough is enough.
He doesn’t know where Emily is, and usually he lets nurses handle the discharge. But she seems attached to this one, and it’ll probably just go faster if Will does it himself. This is his intent, anyway, but Will should know by now about how best laid plans go.
As in, they don’t go.
At all.
-o-
When Will enters the room, he’s surprised at first to see Emily already there. She’s back in the chair, pulled up close to Mr. Garside’s bed. She’s intent as she looks at him, and her fingers are curled around his.
For a second, this is all he sees.
But then he sees the monitors.
Turned to silent, there’s no sound, but the unmistakable flatline is impossible to miss. There are no vital statistics displayed, as the blood pressure and oxygenation levels are at zero. On the bed, Mr. Garside is still and drawn, and Will knows, then.
Will knows.
Emily looks back at him, eyes wide with surprise.
“He’s coding,” she says belatedly. “You should run the code.”
It’s an impossible moment; it’s a moment fraught with a million emotions Will can’t make sense of. He looks at Emily, and she looks back, and the things he wants to ask don’t matter.
Not while the patient is dying.
Not while the patient is--
Not dead, he reminds himself. Not dead until Will calls it.
And Will’s not calling anything yet.
Denial is a powerful tool, after all.
It’s about the only thing Will has left.
-o-
Will runs the code by rote. This time, he barely looks to Emily for help, and he’s surprised to find her marginally responsive. She prepares the epi. She hands him the paddles.
She’s standing there, at his side, when none of it works.
She’s standing there when he gives up.
She’s standing there when he calls time of death.
She’s just standing there.
-o-
Turning away, Will is momentarily overcome by the shock of it all. He loses patients; it happens. Unexpectedly. Suddenly. Violently. Painfully.
But he can’t make this parse.
“He was fine,” Will says, exhaling in a rush as he tries to steady himself. It doesn’t quite work.
Emily leans closer. “There was nothing you could do,” she says, as if to soothe him. She touches the back of his arm.
He shudders, closing his eyes and swallowing hard.
“Dr. Halstead, it looks like a massive MI,” she says. “You couldn’t have done anything.”
He opens his eyes, almost laughing in his grief. “I ran the cardiac panels. I knew his history, and he was fine,” he says, and he shakes his head as he looks at her. “He wasn’t at risk of a heart attack.”
“Our risk is always more than medical,” she says. “His emotional state--”
Will wants to scream a little, and he just keeps shaking his head. “But Emily, he was fine. I mean, you were here. What happened?”
She stops short, then, as if thinking about her answer. She draws back a step. “I came in. I found him like this. I was checking his vitals when you came in.”
It sounds like the right answer, but Will finds himself frowning. “Why were the monitors off?”
She shrugs. “I don’t know.”
It seems like an irrelevant point. It’s not going to bring him back. He looks back at the body, and the feeling grips deep in his gut. “But Emily, I was going to discharge him. He was fine.”
He says it again, and he means it. He says it like it should bring him back even though Will’s already noted time of death in the chart.
This time, Emily steps closer once more. “Dr. Halstead, you have to listen to me. I’ve been telling you since I got here that you focus too much on the physical. We have to treat the mental. That’s where the real suffering occurs. That’s the only place where true healing can happen. And for some people, even when their bodies are whole, the emotional healing just isn’t possible.”
It’s not enough, though. Will shakes his head, more adamant than ever. “What? You think his divorce killed him? His fear of a ruined relationship with his daughter stopped his heart?”
He’s being flippant; she’s being earnest. “It might have,” she suggests.
He groans and turns away from her. “Emily, come on--”
She doesn’t back away this time. “I’m being honest with you, Dr. Halstead. I’m being honest with you because I think, somewhere inside you, you understand,” she says. “But you need perspective. You’re a good doctor -- a great doctor -- but you’re wrapped up on the wrong things. You have to focus on the bigger picture. Then, everything will be better. Then, you can really start helping patients the way I know you want to.”
Weary, he looks back at her. His shoulders are slumped, and he feels defeated. “What good does it do, though? Emily, Mr. Garside is dead.”
The bluntness of his tone doesn’t even make her flinch. She’s like flint, suddenly. Unbreakable. “And?” she asks. “He was going back to an empty house, working in an empty garage on projects he doesn’t care about. He knew his daughter would never really forgive him, and he’d spend the rest of her life taking her out for dinners she didn’t really want to eat. There are many ways to die, and most of them can’t be fixed by running a code.”
He takes a breath and has to hold it. He looks at her, just barely composed.
She’s equivocating, that’s what she’s doing.
She’s standing a dead man’s side and equivocating.
She’s rationalizing, she’s justifying -- all because this is a man who was entrusted to their care. A man who was supposed to go home. A man who’s lying there -- dead.
“I need you to stop talking,” he says finally. He says it softly. He says it firmly. “Right now.”
It’s as serious as he’s ever been, and she recoils from him slightly. Her look is offended.
He doesn’t understand.
He doesn’t understand her. He doesn’t understand this case. He doesn’t understand himself anymore. All this time, he’s fallen back on the idea that, no matter how bad his choices, he was a good doctor. But his patients keep dying.
There’s nothing back him up anymore.
There’s nothing.
He takes another staggering breath, and he can feel the tears as they burn behind his eyes. “I just -- I need to get out of here,” he says, moving toward the door. “Can you take care of the rest? Can you do that much?”
She looks at him, almost curious, but she nods. “Of course,” she says. “Spending these last few minutes with Mr. Garside is my pleasure.”
And about that, he believes her.
Shaking his head, he makes his way to the door.
“Take care, Dr. Halstead,” she says, and he turns around to look at her. She smiles at him. “I’ll see you tomorrow.”
He shudders again, stomach roiling. He leaves the room, and makes a hard exit to the bathroom. Once there, he empties his stomach in the toilet and gasps on a sob. He throws up again until there’s nothing left but bile.
Until there’s nothing left at all.
-o-
Will might have had plans that night; honestly, he doesn’t remember. He doesn’t remember finishing his charts, and he doesn’t remember his trip home. He doesn’t remember if he’s eaten dinner, and he doesn’t remember a single thing he’s done since calling time of death.
He sits on his bed and thinks about Mr. Garside’s daughter, and he hopes someone found her at the restaurant to let her know.
Doctors deal with this kind of thing -- they face loss in the ED all the time -- but the well worn cliches don’t seem to be enough today.
It happens.
You’re not God.
You can’t save everyone.
Will sighs, and wishes he could just save someone these days.
-o-
Will sleeps, and he sleeps hard. He’s up bright and early, not so much because he’s ready to go but because there's really no other choice.
He makes it to work with plenty of time to spare, and he gets about his day with as little fuss as possible. He doesn’t have the appetite for drama anymore. He doesn’t have the energy for it, either.
And he finds, as he gets to work again, that things with Emily aren’t actually getting any better. Any pretense of improvement has been just that -- pretense. She’s clearly not fitting in with the other nurses, and it’s not clear to Will that any amount of instruction or personal connection is going to make much difference. She’s not the ideal choice for an ED nurse is what Will has concluded, but he’s also concluded that this is not his call.
Therefore, he takes solace in some good news.
Well, it’s not actually good news. It’s actually bad news -- and lots of it.
See, Will’s had an unusual number of patients regress in his care, and the extra paperwork has been drowning him. More than that, it’s a little depressing to see patients he expects to recover flounder.
Therefore, the only good news is that the bad news is more pressing than Emily. He still has to keep her close, just to make sure she doesn’t bother Ethan, but she’s become more of an afterthought while he handles her duties and does his due diligence with his patients.
At this point, he feels somewhat resigned to her. He’s accepted her presence, as strange and off putting thought it may be. He likes to think he can practice medicine with or without her, but tonight, a stack of charts to go through, he’s starting to wonder.
After Mr. Garside’s case yesterday, he has to wonder.
Of all his cases today, he had three of them die. Those numbers aren’t unheard of, but two of them had been relatively stable. One, he’d been prepping to discharge.
Going through the notes, he sees that he had two other patients get worse. He’d admitted one to the ICU in a coma instead of getting him upstairs to surgery. Bad days happen, and he knows this, but this day?
Has been a pretty bad day.
He processes the notes in great detail, double checking his work and making sure he’s made no errors -- both in the medicine and in the procedures. He tries to keep his paperwork impeccable for his probation, and he’s always been unqualified in his patient care.
If that means working two hours past his shift.
Well, then, it’s a good thing he’s got no friends or anything resembling a romantic life left for the time being. He’ll get it back -- someday. Just like he’ll get off probation -- someday.
He’s living today for the hope of someday.
-o-
The days seem to start earlier.
He knows they run later.
She’s there, too. For all that Emily is inconsistent in a trauma room, she puts on the appearance of caring about her job. She’s never late; she’s always working over her shift. It seems like every time he’s here, she’s there.
Good, bad, or the other: it is what it is.
Of all his doubts about Emily’s fit for the ED, he still feels obligated to look out of her. Ethan is counting on him, after all. He’s got to work with what he’s got. All the crap he’s done, Will’s just got to work.
Even with a less than ideal nurse that no one likes.
If he can make her belong, then maybe he’ll make a place for himself as well.
“You’re here late,” he says. The day after Mr. Garside’s death, things had been tense or awkward. But Will is doing his best to get past it. He can’t let medicine be personal -- even when it sometimes feels personal to him. If he’s going to make this work with her, he’s got to put in the work. Besides, she’s been here close to a month, and he keeps hoping that they’ll make a connection that makes all of this seem less weird. “Let me guess. Everyone else pulled rank on you.”
She smiles -- that uncanny, sweet smile of hers. For some reason, it’s starting to send a shiver down Will’s back every time he sees it. He thinks it should be getting better, but the reaction is more pronounced with each passing day.
So much for less weird.
“The perils of being the new girl,” she says, and she meanders toward him and sits down uninvited. “But that comes with the territory. What about you? Why are you pulling a double? Given your experience, I can’t imagine you don’t have tenure.”
Will deflects as politely as he can, regretting that he’d said anything. Once she sits, he knows she’s not going to leave. He makes an effort to ignore her in the most benign way possible, in hopes that she’ll get the hint that he wants to be left alone. “Just trying to do my part.”
As best he figures, that’s true, and he sees no need to air his dirty laundry. Again.
He’s done that enough already. Coming back to work at the same job he was fired from has been hard enough. The one good thing about a new hire is that he gets to start from scratch.
Her brow creased. She’s not getting the hint. At all. “But you do that all day long,” she says. “I see you, Dr. Halstead. You’re the first one in, the last one out. You do twice as much as anyone here.”
“Really, it’s just doing the job,” Will says. “I want to be a team player.”
Again, this is the truth, even if it is the most charitable version of it. He hopes that that can be that.
But Emily isn’t the type to leave well enough alone, it seems.
Her face took a sympathetic turn. “You know, I have heard the rumors.”
Of course she has. Will doesn’t really have to ask what rumors, because of course she has. “Oh?” he says instead.
She nods, nose wrinkled in apparent sympathy. “About what you’ve done.”
He does his best not to sigh, but he can’t quite keep himself from grimacing. He’s trying to connect with her, and he knows sometimes that requires him to talk about himself. He’d just rather not.
Because if Emily’s weird in the ED, Will’s still a bit taboo. They make an odd couple, to be sure.
Mostly, though, it’s a reminder that his situation isn’t over. He can’t let himself think it is. He’s still on probation. He’s still answering to Ethan and Goodwin. He still has to earn his way back in.
Which means, his embarrassment is irrelevant. His frustration is misplaced. He can’t deny anything. “I’ve made some mistakes,” he says, keeping the admission as vague as possible. “Things I’ve owned up to -- things I’m still owning.”
She shrugs softly. “But mistakes -- we’ve all made them,” she says. “And you, you make them for the right reasons, I’m guessing.”
He looks at her, pausing as he frowns. “What?”
She looks back at him, still utterly credulous. “I just mean that your mistakes. You did it to help a patient, didn’t you?”
Will’s frown deepens, and he wonders how much she knows. “Did someone--”
“No, not explicitly,” she assures him quickly. “I’m just saying, they talk about you having some fall from grace, and it doesn’t jive. I know you, and I know how much you care about patients. The only lines you’d cross would be for them.”
Her assessment is surprisingly on point, and Will feels on edge by her insight. There’s part of him that wants to be grateful that someone finally seems to understand, but feeling gratitude toward her makes him inherently uncomfortable.
Because it’s Emily.
He’s not sure what it is about Emily, just that it’s something.
“Yeah,” he says, offering his agreement slowly.
She doesn’t seem to notice his hesitation. “So, that’s what it is,” she chirps. Then, she leans forward somewhat in what has become a familiar gesture. “My bet? You were right.”
He laughs because that’s the only sane reaction to have after all he’s done and all he’s been through. “I was doing it for my patient, but there is protocol for a reason.”
It’s a strange position, really, because he would have done anything to help Natalie’s mother. But, if he had to do it all over again, he’s pretty sure he would have proceeded differently. For Natalie’s sake even more than his own.
She looks at him like he’s just told her a good joke. “But we both know that protocol doesn’t always get it right. I’ve been working with you for a month, Dr. Halstead. I know.”
He’s not sure what she knows, so he leans back and tries to distance himself. “All the same,” he says. “I’ve learned the hard way just how important it is.”
She squeeze his arm. The action is sympathetic, and she smiles.
Why does she always smile like that?
“It’s okay. Dr. Halstead,” she tells him, moving around him and back toward the treatment rooms. “I think I understand you.”
He watches her go, a little dumbfounded. She thinks she understands him? That might be impressive, because he doesn’t understand himself half the time.
And there’s no way in hell he understands her.
-o-
Emily seems to preoccupy him these days, and when he’s always on a case with her, it gives him less opportunities to interact with others. Maybe that’s how everyone wants it, but he finds himself relieved when Maggie still seeks him out.
Just to catch up.
Will is hard up on friends these days, and he’s grateful that Maggie still wants to be seen with him. If his past mistakes weren’t enough to make him damaged goods, he’s sure that his constant association with Emily hasn’t made him popular. All these weeks in the ED, and she’s less integrated than ever.
He asks her about Ben, and she asks him if he’s taking time for himself. He suggests getting football tickets for Ben’s birthday, and she invites him to come tailgating with them some time. It’s all pleasant and good until Maggie remembers to ask about Emily.
“Emily?” he asks, trying to play dumb. Emily makes him feel dumb, sometimes, so it’s probably not that much of a stretch.
“Yeah,” Maggie says. “I feel bad that she’s constantly with you. I was thinking maybe I should talk to Ethan, switch things up.”
Will shakes his head. The thought is appealing, for sure, but it’ll do nothing to help his standing with Ethan -- or Goodwin. “No, it’s fine,” he says. “She just needs the extra support, I think.”
Maggie makes a little face. “How is she doing, then? Is she any better?”
Will shrugs. “A little,” he says. “She’s at least a little more predictable. But you would know just as well as I do, right? She’s one of your nurses.”
Maggie purses her lips, looking put out. “I’ve tried. I really have,” she says. “But she’s elusive. I used to think she was shy, but she seems to be actively avoiding me. She doesn’t really mix with anyone else on the nursing staff. After a month, I think I’ve had all of five conversations with her -- and all of them are short and work related, usually asking her to file her paperwork properly.”
With anyone else, Will would leave it at that. But this is Maggie, and if he’s got anyone who cares about him in this ED, it’s her. “What is it about her, then?” he asks. “I mean, do you think there are tensions? Does Emily not get along with the rest of the staff?”
Maggie wrinkles her nose, a little contemplative. “I wouldn’t call it that exactly,” she says. “It’s like -- there’s no animosity. There’s never any fighting. She’s just -- I don’t know. Not a part of things? I don’t know if she’s avoiding us or if we’re avoiding her, but she’s just doing her own thing.”
Will has to nod, because he knows what Maggie is talking about. “I always find her with patients,” he says. “It’s crazy. She can’t talk to me at all, but put her with a patient? And she knows their whole life story within five minutes.”
Maggie considers this. “You know, I have noticed that. I feel like I’m always dragging her out of patient rooms,” she says. “What’s your take on her, then? You’re the only one who seems to know her at all.”
It’s not a distinction Will is sure he can take much pride in. It’s not even a distinction he’s sure means much. “You’d think I’d know more than I do,” he says, and he shakes his head. “When you talk to her about the nitty gritty, about anatomy or medicine, she knows what she’s talking about. It’s just all off in practical application. Her instincts are just focused on different things. It’s like she hasn’t gotten the rhythm of the ED. Maybe she’s still stuck on home health care.”
Maggie gives him a small nudge. “That’s why you’re the best one to train her, even if you are a doctor,” she says. “No one knows how this ED works like you.”
“Or you,” Will protests with a scoff. “You’ve been running this place since before I got here. I’m just trying to stay afloat in the chaos.”
She swats him again, a little dismissively now. “Oh, please. You do more than that. And I think I’m getting crotchety in my old age. I don’t have the patience you have. I think I would have had her fired by now, so I don’t know how you do it.”
Will inhales sharply, raising his eyebrows. “Well, you should tell Goodwin that. I could use the good word.”
“Hey, I do,” Maggie says, seriously again. “Often.”
Her sincerity embarrasses him, and he realizes he was fishing for the compliment. “I’m just saying I’m not doing that much. And I don’t know if Emily will ever acclimate. It’s hard to say who will be off probation first -- me or her.”
“If I have to pick between the two of you, you win every time, Red,” Maggie jokes. “And you won’t be on probation that much longer. There’s no way.”
There’s every way, as far as Will can tell. He makes a self-effacing expression and attempts to shrug. “But for now.”
Maggie just rolls her eyes at him, but concedes. “For now.”
-o-
Now, though, has been weeks and months. Now seems like forever, if Will’s being honest.
There’d been a time when he’d thought he was making progress.
Now, he’s not so sure.
Because his days get longer. His workload increases. And his patients?
They just keep dying.
-o-
He calls time of death on a 22 year old girl. She’d come in after an auto accident, but she was a frequent flier thanks to her crippling ulcerative colitis. She’d been hoping that she was going into remission, but Will never had the chance to find out. She’d died two hours after admission. Her heart gave out, and that’s that.
Will doesn’t even know how to justify it anymore, and he has to sit down. Right there, next to her dead body, he sits down. The other nurse -- Trini -- has gone to get the death kit, but Emily sits next to him and she slings an arm gently over his back. “It’s okay, Dr. Halstead. It’s not your fault.”
She’s trying to be nice. She’s trying to be sympathetic.
That just makes it worse.
This isn’t about feelings. No, that’s a mistake Will has made far too many times. This isn’t about what he wants or what he can justify. The facts are real. The results are palpable. It cannot be assuaged.
He shakes his head, his jaw tightening. “Isn’t it? Because I’m the doctor. I’m the one who will sign her death certificate.”
She looks at him earnest, fingers smoothing up and down his back. “I’ve told you all along that I don’t think death is the worst thing that happens -- not always,” she says gently. “Come on. I see how hard you work. I see the care and attention you give. You provide a real service to the people who come into this ED, more than any other doctor. All of your patients are truly cared for.”
He scoffs, harsh and bitter as a sob catches in his throat. “Are they? They’re dead now.”
She doesn’t move away, though. She doesn’t flinch. She stares at him until he looks back, and her smile is a force to be reckoned with. “Just keep your perspective, Dr. Halstead,” she tells him. “You’re a good doctor. Believe me. You’re a good doctor.”
As if he can believe her.
Any more than he can believe himself these days.
-o-
Ethan isn’t sure he can do this.
He’s not supposed to say that. In fact, he never does. He steadfastly refuses to say it. He’s taken to every challenge in his life with determination and discipline. He’s never accepted that there’s something about himself he can’t control. He’s a military man; he’s an adept doctor. He can do this.
That’s it, right. That’s the story. Discipline and triumph. Determination and success.
It’s a front he’s fastidiously maintained for everyone else, but for the first time in his life, he’s really not sure it’s true. Not that he hasn’t had rough patches before. He has. Learning to deal with his PTSD was no small order. Going through the ups and downs with his sister had been a personal obstacle. And falling in love with April, just to see it all slip away -- yeah, that’s not easy either.
And then, he goes and hires his mentor, and the day he’s trying to fire him, he gets shot. It’s all Dean’s fault, but Dean’s also the guy who’s given him the ability to walk again, so it’s complicated. So complicated that Ethan has mostly chosen to ignore it. He’s got other things to focus on.
Like, walking.
Like, running an ED.
Like, existing.
Somehow, all three tasks seem equally daunting to Ethan these days, and though he makes no pretense that he’s still struggling, he’s struggling. His pain levels are not exactly in check yet, and he feels like he’s at the end of his rope most days he comes into the ED. His procedures feel flat footed, and his managerial style feels disconnected. And he’s tired. He’s just so, so tired.
Most days, it’s all he can do to show up and get through a shift.
Then, he goes home to his empty apartment and does it all over again.
He’s struggling, and he knows it.
But he does his best to make sure his ED isn’t.
Some days it goes okay.
Most days, however, it’s a little bit of a crap shoot.
And Ethan just hasn’t been feeling very lucky these days.
-o-
Feelings aside, on a practical level Ethan knows things are not as bad as they seem. For all the stress he feels, his ED is operating at acceptable levels. They’re understaffed at the moment -- with the pandemic, most places are -- and it’s been hard to maintain normal levels of operation. Yet, with some creative solutions and clear procedures Ethan has worked with, he’s managed to minimize the impact.
He’s also had to rely heavily on help. Maggie is an incredibly important asset, and he makes no attempt to parlay the situation any other way. He needs her, so if she asks for something, he makes sure it happens. A reliable charge nurse is always the key to success, and Ethan is grateful that with all he doesn’t have, he does have that.
Will is another key feature to his success.
Now, this surprises him sometimes. When he’d first gotten promoted, Will had not taken it well. They’d spent most of the pandemic jockeying around for power; Will wanted the job, and Ethan had wanted the girl. It’s true that Dean had saved Ethan’s life when he’d been shot, but it’s will who’s saved him every day since. Will’s consistent effort in the ED -- his attempt at redemption -- is the only thing keeping them fully afloat.
It’s why Ethan can only say wonderful things about Will.
And he’s still terrified to say too many nice things. If Ms. Goodwin takes Will off probation -- as Will should be by now -- there’s no telling how he’ll react. What if he stops working time and a half? What if he no longer feels compelled to be Ethan’s right hand man? What if he goes back to being his own person with his own mind?
It’s not right to want a yes, man, but it really does help.
Every time he’s supposed to meet with Goodwin, Will’s status is at the top of his mind.
Every time he’s in there, however, he can never get the words out.
Today, he finds, is no different.
The standing weekly meeting is not something Ethan particularly dreads -- he understands the realities of his job are partly administrative -- but they’re not always upbeat meetings. Since he’s been back, he’s had to work with her through performance shortfalls, quote deficiencies, budget lapses and so on.
Fortunately, with Will’s overtime efforts and the hiring of a new nurse, things are finally starting to look up. Ethan goes over the numbers with Goodwin, pointing out the number of patients has gone up, and that patient satisfaction levels are starting to normalize. The budget is still somewhat out of whack, but there are signs of increasing stability that bode well for the future.
There’s just one thing, then.
“The death rate?” Ethan asks, taken aback.
She nods, looking somewhat surprised herself. “I know,” she says. “It’s not a metric I’ve had to watch closely, so I didn’t pay much heed when it was ticking up. But over the last month, it’s pretty hard to miss.”
Ethan flips through the papers, quickly tracking the numbers for himself. If he’s looking for a tabulation error, there’s none to be found.
Their death rate has indeed gone up. And not just a little.
A lot.
“Normal variations do occur, even spikes sometimes,” Ms. Goodwin says. She taps her finger to the page Ethan is looking at. “But there’s something not quite right about these numbers. I had one of our stat people look at it more closely, mess around with things so we had a more proper analysis.”
Ethan looks up, and for a second, he dares to be hopeful.
Ms. Goodwin makes a helpless gesture. “The trend is real. And it’s localized just to our ED.”
Ethan frowns as he sits back. “Have we compared our rates to other hospitals.”
She nods, because she’s naturally already thought of this. “COVID has obviously had an impact across the board, but we’re still the outlier.”
Ethan shakes his head. “These things are usually endemic issues. Uh, infections. Maybe fungus or even mold. If there’s a protocol lapse somewhere, some disturbance in the treatment chain.”
She is still nodding along with him, clearly already anticipating this line of thought. “I had the analysis broken down, as many points of data as we could come up with.”
Ethan sits forward again, renewed interest in solving this problem. “And?”
“And,” she says, looking grim. “It’s not what I expected.”
She produces another file, handing it to Ethan. Ethan takes it, flipping through it. The rates are sorted here, denoted by various sub-categories. There’s separate by admission date, patient status, age, gender, treatment room -- and doctor on the case.
“There’s only one metric that shows any sign of abnormality,” Ms. Goodwin says.
Ethan sees it, but he can’t quite comprehend it. He has to shake his head. “But does this mean?”
She’s still nodded as he looks up, and he watches her sigh with something like regret. “The rise in cases is linked specifically to one ED doctor.”
Ethan looks down again, clearly in disbelief. “Will?”
“The data is pretty clear,” Ms. Goodwin says, even if she seems to take no pleasure in the news.
Ethan has to scoff. “But that doesn’t make any sense.”
“It’s not an indictment of anything,” Ms. Goodwin says. “And the analysis could be entirely circumstantial, but I feel like it’s too compelling not to explore it. We have an obligation to our patients.”
The news still has Ethan baffled. “But I’m telling you, it doesn’t make any sense. And it certainly doesn’t fit with anything that I’m seeing down in the ED.”
She draws another breath and sits back once more, chewing the inside of her lip. “So you haven’t noticed any issues with Dr. Halstead?”
Ethan almost wants to laugh, the insinuation is that ridiculous for him. “With Will? I mean, it’s just the opposite. I think the ED would have gone under by now without Will. He’s the strongest contributor by far. I honestly couldn’t run the place without him.”
His effusive praise makes Ms. Goodwin frown. “But he does have a history. There’s inconsistency there.”
“History of insubordination, maybe,” Ethan says. “But we both know that patient care is Will’s thing. And more than that, he’s been on the straight and narrow. He’s dotted every i, crossed every t.”
“I know you want to believe that -- I know I want to believe that, that his second chance is worth something here,” she says, but she shrugs. “But I don’t know what to do about the evidence.”
“You said it yourself, it’s circumstantial,” Ethan says. “And you’re forgetting that because he’s on probation, I still review his case files. I have to sign off on every patient that he sees -- and I’ve reviewed them all. I haven’t seen a single red flag in his work. For all we know, this is just bad luck.”
She looks wholly unconvinced. “That’s a lot of bad luck.”
In a game of political posturing, Ethan might want to hedge his bets. But Ethan’s too tired for that. Ethan’s too tired for any of this. “I agree,” he says. “But I put my faith in Will.”
“I’m not even saying it’s nefarious or negligent,” Ms. Goodwin points out. “We both know he’s been going above and beyond to prove himself. All the hours he’s working -- it could be burnout just as much as anything. If he’s been pushed too hard, we need to know that, too.”
That’s the first fair point she’s made yet, and it’s the one thing he can agree with. “I can’t imagine it affecting him this much,” Ethan says. “But I’ll talk to him. See how things are going from his perspective.”
He gathers himself to leave, but Ms. Goodwin holds him there with one last word of apparent warning. “Just remember that the data isn’t personal,” she reminds him, somewhat cool. “This isn’t about who we like or dislike. This is about our patients. If there’s anything our patients at risk, I’ll do anything it takes to rectify it. That means, I’ll fire anyone who needs to go.”
She stares Ethan down, so he understands.
“Anyone.”
That includes Will.
That includes him.
Ethan stiffly bobs his head, and sees himself out.
-o-
Ethan heads back down to the ED, and he feels vexed. As consumed as he’s been with his own issues, the wider problem in the ED is something he hasn’t seen coming. All defenses aside, he knows the statistics are pretty bad.
And pretty damning.
There’s something going on in his ED, right there beneath his nose, and Ethan’s missed it.
He’s missed it entirely.
With Dean, he’d at least been tracking the problem. He’d seen it coming months down the pike, which was why he’d been trying to fire Dean in the first place. It’s true that he didn’t see the bullet coming, but none of that situation had blindsided him. He’d known for weeks that Dean was a loose cannon that he needed to deal with.
But this?
This is out of nowhere.
How is the ED death rate that bad?
How is it localized to Will Halstead?
Is it possible he’s overworked? Has Ethan put too much on him? There’s plenty of data about how dangerous overworked doctors can be; it’s why reform of the resident system had been so important.
As an attending, Will doesn’t abide by those same checks and balances. Hell, Ethan’s not even sure Will’s counting his overtime at all. He’s putting in hours and hours and hours, and Ethan’s not tracking it. He’s just letting it happen.
And really, Ethan can’t be sure his personal judgement hasn’t been compromised. He’s tired, and he’s in pain. Most days, he’s barely able to get through a shift. How can he pretend like he’s really monitoring things? Especially something he’s taken for granted like Will. He knows he goes over Will’s charts, but that’s not a close look. If things are wrong on the charts, Ethan might not catch it, not with the cursory attention he’s diverting that way.
Something’s going on in Ethan’s ED.
Will Halstead may be his ticket for finding out what.
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
The next patient on the queue is Edwin Garside.
He’s brought in via ambulance, and he makes a big show about it being unnecessary. He’s shot himself in the foot with a nail gun, you see, and he lives by himself. He’s in a little pain, but he feels pretty good otherwise, but he didn’t want to cause a car accident by pushing on the accelerator too hard and inadvertently passing out.
Will assures him he made the right call, and starts to take the man’s history, having him detail the event, recording his vitals and noting any significant medical history. It’s all very by the book and professional.
Also in the room is Emily, and she is the only nurse assigned to the case as the case is considered non-emergent and the ED is already stacked with patients. While Will takes the professional route, Emily fluffs a pillow for him and starts asking him a series of personal questions.
Will learns he’s got a history of heart problems that have been well controlled for the past 20 years.
Emily learns that he’s going through a moderately contentious divorce and that remodeling his apartment was a whim he undertook while in a midlife crisis.
Will listens as sympathetically as he can while he continues his assessment -- unwrapping the bandage from the paramedics, checking reflexes and confirming his fluids and medications -- before he sees his opening to get this back on track.
“So, tell me more about your heart,” Will says, interjecting while Emily is talking to him about his daughter. “What was the diagnosis?”
Mr. Garside is imminently amenable, and he readily comes back to Will’s point. “Oh, there was some sign of disease back in my 30s, really early onset stuff that they were concerned about,” he explains. “I got referred to a cardiologist straight away to hammer out things like my blood pressure, cholesterol -- you know.”
Will tries not to frown, but he takes this note with due interests. Mr. Garside acts like it’s nothing, but Will’s an ED doc. He doesn’t mess around with heart conditions. “And how’s that been going?”
“Good, I think,” Mr. Garside says. He shrugs. “I mean, it lit a fire under my butt. I got my act together, changed my lifestyle. Health food, exercise, meds -- all of it. The cardiologist says I’m his model patient now, and everything else has been smooth sailing.”
Will smiles at him. “That’s great,” he says. “Have you experienced any chest pains this morning?”
“No,” Mr. Garside says. He turns his smile to Emily now. “Just this nail in my foot.”
She smiles back, a hand on his arm. “And it sounds like you’ve got plenty of other things to worry about.”
“No kidding,” Mr. Garside says, even while Will goes back to probing his foot. “I thought getting my health together would fix things, you know. Stabilize my career. Bring my family together. But the opposite has happened. It’s all just been falling apart. I thought doing woodworking would help me decompress or whatever, but here I am.”
He gestures to himself with some self flagellation.
“Can you move your toes for me, Mr. Garside?” Will asks, trying to better gauge if any tendons have been involved.
Mr. Garside complies.
“Good,” Will says. He feels along the bottom of his foot. “Can you feel this?”
“I can,” he says with a small grimace. “Kind of wish I couldn't.”
“I know,” Will says apologetically. “And once I make sure you’ve got sensation intact, I promise, we’ll give you something to take the edge off.”
“Too bad the bad the rest of life isn’t that easy,” Emily says, laying a hand on his arm reassuringly. “A shot and all our troubles go away.”
Mr. Garside smiles back at her, but Will doesn’t have time for this rabbit hole. The patient’s backstory has relevance, sure. But the most pressing problem is the hole in his foot, and Will needs them all to focus if he’s going to alleviate the pain his patient is in and reduce the risk of infection.
Emily has perhaps taken his touchy-feely approach as tacit consent to continue on in this manner with patients. It’s her way, and Will knows that. But she seems overly invested, more distracted than usual.
“All the same,” Will interjects before Emily can pull away Mr. Garside’s attention entirely. “I assume you’d like to get this taken care of?”
The man nods up at him, grateful. “I would,” he says. “Do you think I’ll be out of here for dinner? I have plans with my daughter.”
“That’s wonderful,” Emily says. “How is she taking the divorce?”
“Not great, honestly,” Mr. Garside says, turning back to her with a sense of commiseration. “That’s why tonight is important to me. She’s taken her mother’s side a bit, I’m afraid. I need to prove to her that I’m still in her corner, no matter how much our lawyers yell at each other.”
“Well, if we get things moving here, I think we can make that happen,” he says, and he forces a smile as he tries to make eye contact with Emily and give her the necessary visual cue that it was time to move it along. She blinks at him benignly, but it’s like she doesn’t see him at all. Will inclines his head at her more purposefully. “Can we prepare Mr. Garside’s foot, please?”
There’s just the slightest edge in his voice, and by now, she knows him well enough to hear it. “Yes,” she says, bustling to her feet. She places her hand back on Mr. Garside’s arm with an encouraging smile. “Of course. You’d like that, right? To be done with this pain?”
The man chortles. “From your mouth to God’s ears, darling,” he drawls.
It’s a charming response, and Will knows immediately it’s going to drag Emily back in. Which is unfortunate. Sometimes, he can indulge her desire to spend time with patients. Today is not one of those days, not with patients lining up and Will’s leash as short as ever. He’s tried to be her friend, and he sort of wishes she could return the favor every now and then.
“We’ll be right back to get started,” Will tells him. He moves around the bed, placing a hand on Emily’s shoulder to get her attention. “I could use your help getting prepped.”
She looks up, and the protest is written all over her face.
But Will grits his teeth and stares back at her.
Uneasily, she lets go of Mr. Garside’s arm. “Of course, Dr. Halstead,” she says, and for about two seconds, she almost sounds like an actual nurse. She smiles back at their patient one last time as Will all but ushers her out the door. “Be back soon, Mr. Garside!”
They make it into the hall, and Will reminds himself. He’s trying to be Emily’s mentor. He needs to be her point person to find success at Med. He’s working to become her friend in an effort to get her acclimated to the culture here.
That’s the goal, and in theory, it doesn’t sound that hard.
But in practical application, Will is struggling.
Will is struggling a lot.
There can be no scene this time. He can’t raise his voice, lose his temper, or show emotion. He doesn’t need to ask her about her schooling or her hobbies. This is clear, simple, cut and dry. Even Emily can understand the basics of procedure when she has to.
The the love of all that is good and holy, he needs her to understand it just this once.
“Look, I know you have a great ability to connect with patients, and you are spectacular and getting them calm,” he says, because starting out with the positive is the best way to give constructive -- and desperate -- feedback.
She beams a little at him. “And I love that you notice.”
Because they’re all vain people in the end. Until your humility is stamped out of your by the consequences of every wrong choice you’ve ever made and you end up on probation as a nursing mentor.
Will seeks his resolve and finds it, but barely so. “But right now, we do need to move things along,” he says. “We are way backed up with patients, and Mr. Garside deserves to get about with his day.”
At this, the pleased look on her face evaporates. “He says that what he wants, but I’m really not sure,” she says. “He covers it well with an amiable disposition, but I think he’s an unhappy man. There’s a lot of hurt inside him.”
Will shakes his head. “Maybe, maybe not,” he says. “But he definitely has a lot of pain in his foot -- and he has dinner plans.”
Emily draws her lips together primly. “He’s scared to go, though,” she says. “To see his daughter. He’s afraid it won’t work.”
“Emily, the result of his dinner with his daughter -- that’s not really for us to control,” he says. “All I know is that he’s got a nail in his foot, and we’ve got to clean the wound and check for signs of damage. Then, we get him out of her so he can make that date and do as he pleases. It’s great to care about the patient’s life -- but we have to remember that the goal is to get them back to their lives as fast as possible.”
To this, her expression turns somewhat funny. “And if that’s not what’s best for them?”
He wrinkles his nose. “Emily, I know you like the moral debates, but we don’t have time,” he says. “Please, get his foot prepped so I can clean it, and we need to get in a script for antibiotics.”
“But he’s unhappy,” Emily says, unable to let this go. “Surely, you can hear it when you listen to him talk.”
“I am listening to him,” Will counters. “And I’m listening to his health story. He’s taking care of himself. And despite the things he’s got going on, he seems to be coping well. If you’re really concerned we can rope in Dr. Charles--”
At this suggestion, her face sours. “Psychiatry is too reductive. It starts with too many suppositions.”
He sighs, and shakes his head. “Emily, we have to treat the problem in front of us. Okay? You can chit chat with him while you do it. But I need it done, okay?”
She grows quiet for a moment, looking at him curiously. Then, finally, slowly, she nods. “Okay,” she agrees. “I completely understand, Dr. Halstead. Focus on the problem at hand. Fast solutions.”
“You got this?” he asks, eyebrows raised.
Her smile turns, sweet and simple around the edges. “I got this.”
-o-
It would be nice if for once, when Sharon Goodwin showed up at work, things were going well. She could have a fast, uncomplicated morning with no surprises or unpleasantries.
That would be nice, for sure.
It’s not particularly realistic.
Especially not for her understaffed hospital with budget constraints operating at overloaded capacity during a damn pandemic.
If it weren’t so stressful, the whole lot of it, it might actually be hilarious how everything that can go wrong does go wrong in her life. To think, she’s looking back on the years of her tumultuous divorce with fondness for how simple they were.
No matter. At least with so much on her plate, there’s no time to sit and thoroughly contemplate how stressed out she is.
Still, as it is, she’s drowning in budget paperwork, and she has to field an unexpected call from a donor that requires her full attention for a good twenty minutes that are not accounted for in her schedule. By the time she’s done, she’s almost forgotten than she has a standing meeting with the Chief of her ED.
Ethan, ever reliable, is waiting for her when she lets him in with an apology.
“We’ll try to keep this brief,” she says, leading him in to sit. She glances back as she moves around her desk. “Unless you have particular concerns.”
He makes a face while he sits, offering her a noncommittal shrug. “I don’t think so,” he says.
She wants to believe him, even if part of her suspects that’s just the kind of thing people say to their boss when they don’t want to tell them the truth.
Unfortunately, it’s also the kind of answer Sharon needs to hear on a day like today. “Good,” she says, settling herself down across from him. “I’ve seen the numbers, the budget report -- everything looks pretty good.”
This is the fast and easy way to look at things, and Sharon doesn’t always opt for the easy way out. But sometimes it is -- well, easier.
There’s just one other agenda item on her meeting with Ethan today. “And how’s the new nurse?” she asks, skimming the notes she’s jotted down in her planner. “Emily Novak?”
The hesitation in Ethan’s face is more pronounced this time, but he works equally hard to cover it. “It’s not been the most natural fit, honestly,” he says, and the admission suggests there’s a lot more to it than that. “But we’re working on getting her up to speed. She does seem very willing. Dedicated.”
Sharon cocks her head, taken aback by the description. Willing and dedicated are fine things to be, but they are not the core essentials of a Med ED nurse. “That’s not telling me much,” she comments, noting to herself that it probably tells her more than it should. The description says nothing of her nursing ability; it’s telling.
Ethan squirms in his seat because he knows it, too. “Honestly, I haven’t worked with her much.”
Now, this admission is even more telling, and at least Sharon doesn’t have to beat around the bush. “Oh?”
Ethan sits forward, still fidgeting in his seat. “I tried setting her up with a nursing mentor, but they’re all so overworked that it was a hard match to make,” he explains. “I talked to Maggie about it, and ultimately I’ve had Will Halstead take over most of her training and direction. He’s been working with her a lot the first few weeks, helping her get acclimated. Maggie agreed that having her mentor with a doctor would be the most streamlined approach, given our unique situation.”
Given that they don’t have a single nurse to spare. It’s the reason Emily had been considered an essential hire in the first place and Sharon had willfully overlooked the lack of professional references.
Yet, the solution isn’t as haphazard as one might think. “I can see that being a good thing,” she muses as she considers it. “For her -- and him. She could use someone with experience in the ED, and Dr. Halstead can always use someone to keep him accountable.”
Two birds, one stone. That kind of efficiency is hard to come by palatably in her line of work.
This does catch Ethan’s attention, however, and his guise breaks for a moment. “Will’s been doing fine,” he says, as though that should be self evident. “He’s been a huge help around the ED, in fact. I wouldn’t call this a punitive measure.”
Sharon lets her head dip to the side again. “Well, if Dr. Halstead is flourishing, then how is Emily faring?”
Sharon watches as Ethan rallies himself to come up with she supposes is a professionally detached kind of answer. “Well, with Will working with her in a supervisory role, I’ve been perfectly comfortable. It really has helped balance out the workflow for the rest of the ED.”
It’s a positive report, but a careful one. There are still things that Ethan Choi is not saying to her right now, but he’s got a pretty good track record. She trusts him to delineate the necessary details -- for both their sakes. “That works,” she says, matter of fact. “And if there’s nothing else?”
Ethan smiles politely and gets to his feet. “Then, I’ll get back to work.”
That makes two of them.
-o-
Sharon tries to let well enough alone. She has a positive report on hand, from one of her most reliable people in the hospital. There is no indication that anything is amiss for once. Everyone and everything seem to be in working order.
More than that, she doesn’t have time to worry. There’s no time to dwell. She can’t chase down her whims and fancies just for her own peace of mind. The ED is fine. She has to take the evidence at face value. Everything in the ED is 100 percent, absolutely just fine.
They’ve got a new nurse on the floor. Growing pains are normal, but it’s helping. There’s no reason to suspect it’s not working.
Before her lunch meeting, she checks her email. At first, Sharon braces herself when she sees an email from Gwen. To her surprise, however, the email is glowing.
Glad to see things in the ED are picking up. We may have to review your current ED budget. I think a few additional discretionary expenditures may be in order. Don’t you need a new x-ray machine? I’ll bring it up at the meeting tonight.
That’s a novelty, to be sure. Sharon takes it as incontrovertible evidence that she has nothing to worry about at all.
-o-
Comparatively, Will thinks today might actually turn out manageable. After his talk with Emily in the morning, she’s been more focused the rest of the day. He hasn’t had to start a single IV or load any of the meds himself. She’s being active and responsive, and Will thinks maybe -- just maybe -- they’ve turned a corner.
As a result, things are getting done, and for once, his workload is actually manageable. As soon as he can get Mr. Garside discharged, he’ll settle down to focus on his rounds, and he might be out of the ED on time for once.
Now, the case with Mr. Garside has been frustratingly long winded. While Emily has been on her game with other patients, for some reason, no progress seems to move ahead with Mr. Garside. Will has cleaned and treated the wound -- no sign of infection or tendon involvement -- and he’s got the medication order in hand. He’s fully ready to discharge the man, but Emily keeps bringing up points to slow things down.
She wants to test Mr. Garside’s range of motion. She wants to explain his medication regimen to him in more detail. Honestly, at a certain point, Will stops keeping track of the reasons, and now that the poor man has been stuck in the ED for most of the day, Will decides enough is enough.
He doesn’t know where Emily is, and usually he lets nurses handle the discharge. But she seems attached to this one, and it’ll probably just go faster if Will does it himself. This is his intent, anyway, but Will should know by now about how best laid plans go.
As in, they don’t go.
At all.
-o-
When Will enters the room, he’s surprised at first to see Emily already there. She’s back in the chair, pulled up close to Mr. Garside’s bed. She’s intent as she looks at him, and her fingers are curled around his.
For a second, this is all he sees.
But then he sees the monitors.
Turned to silent, there’s no sound, but the unmistakable flatline is impossible to miss. There are no vital statistics displayed, as the blood pressure and oxygenation levels are at zero. On the bed, Mr. Garside is still and drawn, and Will knows, then.
Will knows.
Emily looks back at him, eyes wide with surprise.
“He’s coding,” she says belatedly. “You should run the code.”
It’s an impossible moment; it’s a moment fraught with a million emotions Will can’t make sense of. He looks at Emily, and she looks back, and the things he wants to ask don’t matter.
Not while the patient is dying.
Not while the patient is--
Not dead, he reminds himself. Not dead until Will calls it.
And Will’s not calling anything yet.
Denial is a powerful tool, after all.
It’s about the only thing Will has left.
-o-
Will runs the code by rote. This time, he barely looks to Emily for help, and he’s surprised to find her marginally responsive. She prepares the epi. She hands him the paddles.
She’s standing there, at his side, when none of it works.
She’s standing there when he gives up.
She’s standing there when he calls time of death.
She’s just standing there.
-o-
Turning away, Will is momentarily overcome by the shock of it all. He loses patients; it happens. Unexpectedly. Suddenly. Violently. Painfully.
But he can’t make this parse.
“He was fine,” Will says, exhaling in a rush as he tries to steady himself. It doesn’t quite work.
Emily leans closer. “There was nothing you could do,” she says, as if to soothe him. She touches the back of his arm.
He shudders, closing his eyes and swallowing hard.
“Dr. Halstead, it looks like a massive MI,” she says. “You couldn’t have done anything.”
He opens his eyes, almost laughing in his grief. “I ran the cardiac panels. I knew his history, and he was fine,” he says, and he shakes his head as he looks at her. “He wasn’t at risk of a heart attack.”
“Our risk is always more than medical,” she says. “His emotional state--”
Will wants to scream a little, and he just keeps shaking his head. “But Emily, he was fine. I mean, you were here. What happened?”
She stops short, then, as if thinking about her answer. She draws back a step. “I came in. I found him like this. I was checking his vitals when you came in.”
It sounds like the right answer, but Will finds himself frowning. “Why were the monitors off?”
She shrugs. “I don’t know.”
It seems like an irrelevant point. It’s not going to bring him back. He looks back at the body, and the feeling grips deep in his gut. “But Emily, I was going to discharge him. He was fine.”
He says it again, and he means it. He says it like it should bring him back even though Will’s already noted time of death in the chart.
This time, Emily steps closer once more. “Dr. Halstead, you have to listen to me. I’ve been telling you since I got here that you focus too much on the physical. We have to treat the mental. That’s where the real suffering occurs. That’s the only place where true healing can happen. And for some people, even when their bodies are whole, the emotional healing just isn’t possible.”
It’s not enough, though. Will shakes his head, more adamant than ever. “What? You think his divorce killed him? His fear of a ruined relationship with his daughter stopped his heart?”
He’s being flippant; she’s being earnest. “It might have,” she suggests.
He groans and turns away from her. “Emily, come on--”
She doesn’t back away this time. “I’m being honest with you, Dr. Halstead. I’m being honest with you because I think, somewhere inside you, you understand,” she says. “But you need perspective. You’re a good doctor -- a great doctor -- but you’re wrapped up on the wrong things. You have to focus on the bigger picture. Then, everything will be better. Then, you can really start helping patients the way I know you want to.”
Weary, he looks back at her. His shoulders are slumped, and he feels defeated. “What good does it do, though? Emily, Mr. Garside is dead.”
The bluntness of his tone doesn’t even make her flinch. She’s like flint, suddenly. Unbreakable. “And?” she asks. “He was going back to an empty house, working in an empty garage on projects he doesn’t care about. He knew his daughter would never really forgive him, and he’d spend the rest of her life taking her out for dinners she didn’t really want to eat. There are many ways to die, and most of them can’t be fixed by running a code.”
He takes a breath and has to hold it. He looks at her, just barely composed.
She’s equivocating, that’s what she’s doing.
She’s standing a dead man’s side and equivocating.
She’s rationalizing, she’s justifying -- all because this is a man who was entrusted to their care. A man who was supposed to go home. A man who’s lying there -- dead.
“I need you to stop talking,” he says finally. He says it softly. He says it firmly. “Right now.”
It’s as serious as he’s ever been, and she recoils from him slightly. Her look is offended.
He doesn’t understand.
He doesn’t understand her. He doesn’t understand this case. He doesn’t understand himself anymore. All this time, he’s fallen back on the idea that, no matter how bad his choices, he was a good doctor. But his patients keep dying.
There’s nothing back him up anymore.
There’s nothing.
He takes another staggering breath, and he can feel the tears as they burn behind his eyes. “I just -- I need to get out of here,” he says, moving toward the door. “Can you take care of the rest? Can you do that much?”
She looks at him, almost curious, but she nods. “Of course,” she says. “Spending these last few minutes with Mr. Garside is my pleasure.”
And about that, he believes her.
Shaking his head, he makes his way to the door.
“Take care, Dr. Halstead,” she says, and he turns around to look at her. She smiles at him. “I’ll see you tomorrow.”
He shudders again, stomach roiling. He leaves the room, and makes a hard exit to the bathroom. Once there, he empties his stomach in the toilet and gasps on a sob. He throws up again until there’s nothing left but bile.
Until there’s nothing left at all.
-o-
Will might have had plans that night; honestly, he doesn’t remember. He doesn’t remember finishing his charts, and he doesn’t remember his trip home. He doesn’t remember if he’s eaten dinner, and he doesn’t remember a single thing he’s done since calling time of death.
He sits on his bed and thinks about Mr. Garside’s daughter, and he hopes someone found her at the restaurant to let her know.
Doctors deal with this kind of thing -- they face loss in the ED all the time -- but the well worn cliches don’t seem to be enough today.
It happens.
You’re not God.
You can’t save everyone.
Will sighs, and wishes he could just save someone these days.
-o-
Will sleeps, and he sleeps hard. He’s up bright and early, not so much because he’s ready to go but because there's really no other choice.
He makes it to work with plenty of time to spare, and he gets about his day with as little fuss as possible. He doesn’t have the appetite for drama anymore. He doesn’t have the energy for it, either.
And he finds, as he gets to work again, that things with Emily aren’t actually getting any better. Any pretense of improvement has been just that -- pretense. She’s clearly not fitting in with the other nurses, and it’s not clear to Will that any amount of instruction or personal connection is going to make much difference. She’s not the ideal choice for an ED nurse is what Will has concluded, but he’s also concluded that this is not his call.
Therefore, he takes solace in some good news.
Well, it’s not actually good news. It’s actually bad news -- and lots of it.
See, Will’s had an unusual number of patients regress in his care, and the extra paperwork has been drowning him. More than that, it’s a little depressing to see patients he expects to recover flounder.
Therefore, the only good news is that the bad news is more pressing than Emily. He still has to keep her close, just to make sure she doesn’t bother Ethan, but she’s become more of an afterthought while he handles her duties and does his due diligence with his patients.
At this point, he feels somewhat resigned to her. He’s accepted her presence, as strange and off putting thought it may be. He likes to think he can practice medicine with or without her, but tonight, a stack of charts to go through, he’s starting to wonder.
After Mr. Garside’s case yesterday, he has to wonder.
Of all his cases today, he had three of them die. Those numbers aren’t unheard of, but two of them had been relatively stable. One, he’d been prepping to discharge.
Going through the notes, he sees that he had two other patients get worse. He’d admitted one to the ICU in a coma instead of getting him upstairs to surgery. Bad days happen, and he knows this, but this day?
Has been a pretty bad day.
He processes the notes in great detail, double checking his work and making sure he’s made no errors -- both in the medicine and in the procedures. He tries to keep his paperwork impeccable for his probation, and he’s always been unqualified in his patient care.
If that means working two hours past his shift.
Well, then, it’s a good thing he’s got no friends or anything resembling a romantic life left for the time being. He’ll get it back -- someday. Just like he’ll get off probation -- someday.
He’s living today for the hope of someday.
-o-
The days seem to start earlier.
He knows they run later.
She’s there, too. For all that Emily is inconsistent in a trauma room, she puts on the appearance of caring about her job. She’s never late; she’s always working over her shift. It seems like every time he’s here, she’s there.
Good, bad, or the other: it is what it is.
Of all his doubts about Emily’s fit for the ED, he still feels obligated to look out of her. Ethan is counting on him, after all. He’s got to work with what he’s got. All the crap he’s done, Will’s just got to work.
Even with a less than ideal nurse that no one likes.
If he can make her belong, then maybe he’ll make a place for himself as well.
“You’re here late,” he says. The day after Mr. Garside’s death, things had been tense or awkward. But Will is doing his best to get past it. He can’t let medicine be personal -- even when it sometimes feels personal to him. If he’s going to make this work with her, he’s got to put in the work. Besides, she’s been here close to a month, and he keeps hoping that they’ll make a connection that makes all of this seem less weird. “Let me guess. Everyone else pulled rank on you.”
She smiles -- that uncanny, sweet smile of hers. For some reason, it’s starting to send a shiver down Will’s back every time he sees it. He thinks it should be getting better, but the reaction is more pronounced with each passing day.
So much for less weird.
“The perils of being the new girl,” she says, and she meanders toward him and sits down uninvited. “But that comes with the territory. What about you? Why are you pulling a double? Given your experience, I can’t imagine you don’t have tenure.”
Will deflects as politely as he can, regretting that he’d said anything. Once she sits, he knows she’s not going to leave. He makes an effort to ignore her in the most benign way possible, in hopes that she’ll get the hint that he wants to be left alone. “Just trying to do my part.”
As best he figures, that’s true, and he sees no need to air his dirty laundry. Again.
He’s done that enough already. Coming back to work at the same job he was fired from has been hard enough. The one good thing about a new hire is that he gets to start from scratch.
Her brow creased. She’s not getting the hint. At all. “But you do that all day long,” she says. “I see you, Dr. Halstead. You’re the first one in, the last one out. You do twice as much as anyone here.”
“Really, it’s just doing the job,” Will says. “I want to be a team player.”
Again, this is the truth, even if it is the most charitable version of it. He hopes that that can be that.
But Emily isn’t the type to leave well enough alone, it seems.
Her face took a sympathetic turn. “You know, I have heard the rumors.”
Of course she has. Will doesn’t really have to ask what rumors, because of course she has. “Oh?” he says instead.
She nods, nose wrinkled in apparent sympathy. “About what you’ve done.”
He does his best not to sigh, but he can’t quite keep himself from grimacing. He’s trying to connect with her, and he knows sometimes that requires him to talk about himself. He’d just rather not.
Because if Emily’s weird in the ED, Will’s still a bit taboo. They make an odd couple, to be sure.
Mostly, though, it’s a reminder that his situation isn’t over. He can’t let himself think it is. He’s still on probation. He’s still answering to Ethan and Goodwin. He still has to earn his way back in.
Which means, his embarrassment is irrelevant. His frustration is misplaced. He can’t deny anything. “I’ve made some mistakes,” he says, keeping the admission as vague as possible. “Things I’ve owned up to -- things I’m still owning.”
She shrugs softly. “But mistakes -- we’ve all made them,” she says. “And you, you make them for the right reasons, I’m guessing.”
He looks at her, pausing as he frowns. “What?”
She looks back at him, still utterly credulous. “I just mean that your mistakes. You did it to help a patient, didn’t you?”
Will’s frown deepens, and he wonders how much she knows. “Did someone--”
“No, not explicitly,” she assures him quickly. “I’m just saying, they talk about you having some fall from grace, and it doesn’t jive. I know you, and I know how much you care about patients. The only lines you’d cross would be for them.”
Her assessment is surprisingly on point, and Will feels on edge by her insight. There’s part of him that wants to be grateful that someone finally seems to understand, but feeling gratitude toward her makes him inherently uncomfortable.
Because it’s Emily.
He’s not sure what it is about Emily, just that it’s something.
“Yeah,” he says, offering his agreement slowly.
She doesn’t seem to notice his hesitation. “So, that’s what it is,” she chirps. Then, she leans forward somewhat in what has become a familiar gesture. “My bet? You were right.”
He laughs because that’s the only sane reaction to have after all he’s done and all he’s been through. “I was doing it for my patient, but there is protocol for a reason.”
It’s a strange position, really, because he would have done anything to help Natalie’s mother. But, if he had to do it all over again, he’s pretty sure he would have proceeded differently. For Natalie’s sake even more than his own.
She looks at him like he’s just told her a good joke. “But we both know that protocol doesn’t always get it right. I’ve been working with you for a month, Dr. Halstead. I know.”
He’s not sure what she knows, so he leans back and tries to distance himself. “All the same,” he says. “I’ve learned the hard way just how important it is.”
She squeeze his arm. The action is sympathetic, and she smiles.
Why does she always smile like that?
“It’s okay. Dr. Halstead,” she tells him, moving around him and back toward the treatment rooms. “I think I understand you.”
He watches her go, a little dumbfounded. She thinks she understands him? That might be impressive, because he doesn’t understand himself half the time.
And there’s no way in hell he understands her.
-o-
Emily seems to preoccupy him these days, and when he’s always on a case with her, it gives him less opportunities to interact with others. Maybe that’s how everyone wants it, but he finds himself relieved when Maggie still seeks him out.
Just to catch up.
Will is hard up on friends these days, and he’s grateful that Maggie still wants to be seen with him. If his past mistakes weren’t enough to make him damaged goods, he’s sure that his constant association with Emily hasn’t made him popular. All these weeks in the ED, and she’s less integrated than ever.
He asks her about Ben, and she asks him if he’s taking time for himself. He suggests getting football tickets for Ben’s birthday, and she invites him to come tailgating with them some time. It’s all pleasant and good until Maggie remembers to ask about Emily.
“Emily?” he asks, trying to play dumb. Emily makes him feel dumb, sometimes, so it’s probably not that much of a stretch.
“Yeah,” Maggie says. “I feel bad that she’s constantly with you. I was thinking maybe I should talk to Ethan, switch things up.”
Will shakes his head. The thought is appealing, for sure, but it’ll do nothing to help his standing with Ethan -- or Goodwin. “No, it’s fine,” he says. “She just needs the extra support, I think.”
Maggie makes a little face. “How is she doing, then? Is she any better?”
Will shrugs. “A little,” he says. “She’s at least a little more predictable. But you would know just as well as I do, right? She’s one of your nurses.”
Maggie purses her lips, looking put out. “I’ve tried. I really have,” she says. “But she’s elusive. I used to think she was shy, but she seems to be actively avoiding me. She doesn’t really mix with anyone else on the nursing staff. After a month, I think I’ve had all of five conversations with her -- and all of them are short and work related, usually asking her to file her paperwork properly.”
With anyone else, Will would leave it at that. But this is Maggie, and if he’s got anyone who cares about him in this ED, it’s her. “What is it about her, then?” he asks. “I mean, do you think there are tensions? Does Emily not get along with the rest of the staff?”
Maggie wrinkles her nose, a little contemplative. “I wouldn’t call it that exactly,” she says. “It’s like -- there’s no animosity. There’s never any fighting. She’s just -- I don’t know. Not a part of things? I don’t know if she’s avoiding us or if we’re avoiding her, but she’s just doing her own thing.”
Will has to nod, because he knows what Maggie is talking about. “I always find her with patients,” he says. “It’s crazy. She can’t talk to me at all, but put her with a patient? And she knows their whole life story within five minutes.”
Maggie considers this. “You know, I have noticed that. I feel like I’m always dragging her out of patient rooms,” she says. “What’s your take on her, then? You’re the only one who seems to know her at all.”
It’s not a distinction Will is sure he can take much pride in. It’s not even a distinction he’s sure means much. “You’d think I’d know more than I do,” he says, and he shakes his head. “When you talk to her about the nitty gritty, about anatomy or medicine, she knows what she’s talking about. It’s just all off in practical application. Her instincts are just focused on different things. It’s like she hasn’t gotten the rhythm of the ED. Maybe she’s still stuck on home health care.”
Maggie gives him a small nudge. “That’s why you’re the best one to train her, even if you are a doctor,” she says. “No one knows how this ED works like you.”
“Or you,” Will protests with a scoff. “You’ve been running this place since before I got here. I’m just trying to stay afloat in the chaos.”
She swats him again, a little dismissively now. “Oh, please. You do more than that. And I think I’m getting crotchety in my old age. I don’t have the patience you have. I think I would have had her fired by now, so I don’t know how you do it.”
Will inhales sharply, raising his eyebrows. “Well, you should tell Goodwin that. I could use the good word.”
“Hey, I do,” Maggie says, seriously again. “Often.”
Her sincerity embarrasses him, and he realizes he was fishing for the compliment. “I’m just saying I’m not doing that much. And I don’t know if Emily will ever acclimate. It’s hard to say who will be off probation first -- me or her.”
“If I have to pick between the two of you, you win every time, Red,” Maggie jokes. “And you won’t be on probation that much longer. There’s no way.”
There’s every way, as far as Will can tell. He makes a self-effacing expression and attempts to shrug. “But for now.”
Maggie just rolls her eyes at him, but concedes. “For now.”
-o-
Now, though, has been weeks and months. Now seems like forever, if Will’s being honest.
There’d been a time when he’d thought he was making progress.
Now, he’s not so sure.
Because his days get longer. His workload increases. And his patients?
They just keep dying.
-o-
He calls time of death on a 22 year old girl. She’d come in after an auto accident, but she was a frequent flier thanks to her crippling ulcerative colitis. She’d been hoping that she was going into remission, but Will never had the chance to find out. She’d died two hours after admission. Her heart gave out, and that’s that.
Will doesn’t even know how to justify it anymore, and he has to sit down. Right there, next to her dead body, he sits down. The other nurse -- Trini -- has gone to get the death kit, but Emily sits next to him and she slings an arm gently over his back. “It’s okay, Dr. Halstead. It’s not your fault.”
She’s trying to be nice. She’s trying to be sympathetic.
That just makes it worse.
This isn’t about feelings. No, that’s a mistake Will has made far too many times. This isn’t about what he wants or what he can justify. The facts are real. The results are palpable. It cannot be assuaged.
He shakes his head, his jaw tightening. “Isn’t it? Because I’m the doctor. I’m the one who will sign her death certificate.”
She looks at him earnest, fingers smoothing up and down his back. “I’ve told you all along that I don’t think death is the worst thing that happens -- not always,” she says gently. “Come on. I see how hard you work. I see the care and attention you give. You provide a real service to the people who come into this ED, more than any other doctor. All of your patients are truly cared for.”
He scoffs, harsh and bitter as a sob catches in his throat. “Are they? They’re dead now.”
She doesn’t move away, though. She doesn’t flinch. She stares at him until he looks back, and her smile is a force to be reckoned with. “Just keep your perspective, Dr. Halstead,” she tells him. “You’re a good doctor. Believe me. You’re a good doctor.”
As if he can believe her.
Any more than he can believe himself these days.
-o-
Ethan isn’t sure he can do this.
He’s not supposed to say that. In fact, he never does. He steadfastly refuses to say it. He’s taken to every challenge in his life with determination and discipline. He’s never accepted that there’s something about himself he can’t control. He’s a military man; he’s an adept doctor. He can do this.
That’s it, right. That’s the story. Discipline and triumph. Determination and success.
It’s a front he’s fastidiously maintained for everyone else, but for the first time in his life, he’s really not sure it’s true. Not that he hasn’t had rough patches before. He has. Learning to deal with his PTSD was no small order. Going through the ups and downs with his sister had been a personal obstacle. And falling in love with April, just to see it all slip away -- yeah, that’s not easy either.
And then, he goes and hires his mentor, and the day he’s trying to fire him, he gets shot. It’s all Dean’s fault, but Dean’s also the guy who’s given him the ability to walk again, so it’s complicated. So complicated that Ethan has mostly chosen to ignore it. He’s got other things to focus on.
Like, walking.
Like, running an ED.
Like, existing.
Somehow, all three tasks seem equally daunting to Ethan these days, and though he makes no pretense that he’s still struggling, he’s struggling. His pain levels are not exactly in check yet, and he feels like he’s at the end of his rope most days he comes into the ED. His procedures feel flat footed, and his managerial style feels disconnected. And he’s tired. He’s just so, so tired.
Most days, it’s all he can do to show up and get through a shift.
Then, he goes home to his empty apartment and does it all over again.
He’s struggling, and he knows it.
But he does his best to make sure his ED isn’t.
Some days it goes okay.
Most days, however, it’s a little bit of a crap shoot.
And Ethan just hasn’t been feeling very lucky these days.
-o-
Feelings aside, on a practical level Ethan knows things are not as bad as they seem. For all the stress he feels, his ED is operating at acceptable levels. They’re understaffed at the moment -- with the pandemic, most places are -- and it’s been hard to maintain normal levels of operation. Yet, with some creative solutions and clear procedures Ethan has worked with, he’s managed to minimize the impact.
He’s also had to rely heavily on help. Maggie is an incredibly important asset, and he makes no attempt to parlay the situation any other way. He needs her, so if she asks for something, he makes sure it happens. A reliable charge nurse is always the key to success, and Ethan is grateful that with all he doesn’t have, he does have that.
Will is another key feature to his success.
Now, this surprises him sometimes. When he’d first gotten promoted, Will had not taken it well. They’d spent most of the pandemic jockeying around for power; Will wanted the job, and Ethan had wanted the girl. It’s true that Dean had saved Ethan’s life when he’d been shot, but it’s will who’s saved him every day since. Will’s consistent effort in the ED -- his attempt at redemption -- is the only thing keeping them fully afloat.
It’s why Ethan can only say wonderful things about Will.
And he’s still terrified to say too many nice things. If Ms. Goodwin takes Will off probation -- as Will should be by now -- there’s no telling how he’ll react. What if he stops working time and a half? What if he no longer feels compelled to be Ethan’s right hand man? What if he goes back to being his own person with his own mind?
It’s not right to want a yes, man, but it really does help.
Every time he’s supposed to meet with Goodwin, Will’s status is at the top of his mind.
Every time he’s in there, however, he can never get the words out.
Today, he finds, is no different.
The standing weekly meeting is not something Ethan particularly dreads -- he understands the realities of his job are partly administrative -- but they’re not always upbeat meetings. Since he’s been back, he’s had to work with her through performance shortfalls, quote deficiencies, budget lapses and so on.
Fortunately, with Will’s overtime efforts and the hiring of a new nurse, things are finally starting to look up. Ethan goes over the numbers with Goodwin, pointing out the number of patients has gone up, and that patient satisfaction levels are starting to normalize. The budget is still somewhat out of whack, but there are signs of increasing stability that bode well for the future.
There’s just one thing, then.
“The death rate?” Ethan asks, taken aback.
She nods, looking somewhat surprised herself. “I know,” she says. “It’s not a metric I’ve had to watch closely, so I didn’t pay much heed when it was ticking up. But over the last month, it’s pretty hard to miss.”
Ethan flips through the papers, quickly tracking the numbers for himself. If he’s looking for a tabulation error, there’s none to be found.
Their death rate has indeed gone up. And not just a little.
A lot.
“Normal variations do occur, even spikes sometimes,” Ms. Goodwin says. She taps her finger to the page Ethan is looking at. “But there’s something not quite right about these numbers. I had one of our stat people look at it more closely, mess around with things so we had a more proper analysis.”
Ethan looks up, and for a second, he dares to be hopeful.
Ms. Goodwin makes a helpless gesture. “The trend is real. And it’s localized just to our ED.”
Ethan frowns as he sits back. “Have we compared our rates to other hospitals.”
She nods, because she’s naturally already thought of this. “COVID has obviously had an impact across the board, but we’re still the outlier.”
Ethan shakes his head. “These things are usually endemic issues. Uh, infections. Maybe fungus or even mold. If there’s a protocol lapse somewhere, some disturbance in the treatment chain.”
She is still nodding along with him, clearly already anticipating this line of thought. “I had the analysis broken down, as many points of data as we could come up with.”
Ethan sits forward again, renewed interest in solving this problem. “And?”
“And,” she says, looking grim. “It’s not what I expected.”
She produces another file, handing it to Ethan. Ethan takes it, flipping through it. The rates are sorted here, denoted by various sub-categories. There’s separate by admission date, patient status, age, gender, treatment room -- and doctor on the case.
“There’s only one metric that shows any sign of abnormality,” Ms. Goodwin says.
Ethan sees it, but he can’t quite comprehend it. He has to shake his head. “But does this mean?”
She’s still nodded as he looks up, and he watches her sigh with something like regret. “The rise in cases is linked specifically to one ED doctor.”
Ethan looks down again, clearly in disbelief. “Will?”
“The data is pretty clear,” Ms. Goodwin says, even if she seems to take no pleasure in the news.
Ethan has to scoff. “But that doesn’t make any sense.”
“It’s not an indictment of anything,” Ms. Goodwin says. “And the analysis could be entirely circumstantial, but I feel like it’s too compelling not to explore it. We have an obligation to our patients.”
The news still has Ethan baffled. “But I’m telling you, it doesn’t make any sense. And it certainly doesn’t fit with anything that I’m seeing down in the ED.”
She draws another breath and sits back once more, chewing the inside of her lip. “So you haven’t noticed any issues with Dr. Halstead?”
Ethan almost wants to laugh, the insinuation is that ridiculous for him. “With Will? I mean, it’s just the opposite. I think the ED would have gone under by now without Will. He’s the strongest contributor by far. I honestly couldn’t run the place without him.”
His effusive praise makes Ms. Goodwin frown. “But he does have a history. There’s inconsistency there.”
“History of insubordination, maybe,” Ethan says. “But we both know that patient care is Will’s thing. And more than that, he’s been on the straight and narrow. He’s dotted every i, crossed every t.”
“I know you want to believe that -- I know I want to believe that, that his second chance is worth something here,” she says, but she shrugs. “But I don’t know what to do about the evidence.”
“You said it yourself, it’s circumstantial,” Ethan says. “And you’re forgetting that because he’s on probation, I still review his case files. I have to sign off on every patient that he sees -- and I’ve reviewed them all. I haven’t seen a single red flag in his work. For all we know, this is just bad luck.”
She looks wholly unconvinced. “That’s a lot of bad luck.”
In a game of political posturing, Ethan might want to hedge his bets. But Ethan’s too tired for that. Ethan’s too tired for any of this. “I agree,” he says. “But I put my faith in Will.”
“I’m not even saying it’s nefarious or negligent,” Ms. Goodwin points out. “We both know he’s been going above and beyond to prove himself. All the hours he’s working -- it could be burnout just as much as anything. If he’s been pushed too hard, we need to know that, too.”
That’s the first fair point she’s made yet, and it’s the one thing he can agree with. “I can’t imagine it affecting him this much,” Ethan says. “But I’ll talk to him. See how things are going from his perspective.”
He gathers himself to leave, but Ms. Goodwin holds him there with one last word of apparent warning. “Just remember that the data isn’t personal,” she reminds him, somewhat cool. “This isn’t about who we like or dislike. This is about our patients. If there’s anything our patients at risk, I’ll do anything it takes to rectify it. That means, I’ll fire anyone who needs to go.”
She stares Ethan down, so he understands.
“Anyone.”
That includes Will.
That includes him.
Ethan stiffly bobs his head, and sees himself out.
-o-
Ethan heads back down to the ED, and he feels vexed. As consumed as he’s been with his own issues, the wider problem in the ED is something he hasn’t seen coming. All defenses aside, he knows the statistics are pretty bad.
And pretty damning.
There’s something going on in his ED, right there beneath his nose, and Ethan’s missed it.
He’s missed it entirely.
With Dean, he’d at least been tracking the problem. He’d seen it coming months down the pike, which was why he’d been trying to fire Dean in the first place. It’s true that he didn’t see the bullet coming, but none of that situation had blindsided him. He’d known for weeks that Dean was a loose cannon that he needed to deal with.
But this?
This is out of nowhere.
How is the ED death rate that bad?
How is it localized to Will Halstead?
Is it possible he’s overworked? Has Ethan put too much on him? There’s plenty of data about how dangerous overworked doctors can be; it’s why reform of the resident system had been so important.
As an attending, Will doesn’t abide by those same checks and balances. Hell, Ethan’s not even sure Will’s counting his overtime at all. He’s putting in hours and hours and hours, and Ethan’s not tracking it. He’s just letting it happen.
And really, Ethan can’t be sure his personal judgement hasn’t been compromised. He’s tired, and he’s in pain. Most days, he’s barely able to get through a shift. How can he pretend like he’s really monitoring things? Especially something he’s taken for granted like Will. He knows he goes over Will’s charts, but that’s not a close look. If things are wrong on the charts, Ethan might not catch it, not with the cursory attention he’s diverting that way.
Something’s going on in Ethan’s ED.
Will Halstead may be his ticket for finding out what.