Chicago Med fic: Mercy (4/10)
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
Will thinks if he just works harder. If he just puts in more effort. If he just pays closer attention. He memorizes the policies. He masters all the procedural elements to the ED. He spends every second of every day fully invested in his work. He’s taken to giving patients his full and undivided attention. He stays for more procedures. He transfers them to other wings himself. He’s done taking chances.
He won’t take a beating heart for granted ever again.
Not that it matters.
The more he cares, the harder he works -- the worse it gets. They just keep dying. From big things. From little things. Will always comes in when they’re crashing, and he’s just in time to run the code. He makes nice with Nina again down in pathology, and he starts checking up on every autopsy just to see. She smiles at him apologetically -- bygones have been bygones, and she’s married now -- and tells him that it’s natural causes.
“It happens,” she says. “I see it all day, every day.”
“But so many of them are my patients,” Will says, feeling bereft over the latest. A 50 year old woman -- a school teacher. She survived cancer and covid, but here she is, dead after cutting herself with a knife while chopping vegetables for dinner.
She’s supposed to take her kid to a soccer tournament this weekend.
“Will, there have been no red flags,” Nina says, and she stops what she is doing to look at him. “It’s just a lot of bad luck.”
-o-
Bad luck seems like a copout. It is a copout, and Will should know. It’s one he’s tried to use for years. But he’s in a new era of responsibility. It doesn’t fly. He can’t let it fly.
So if his luck is bad, he has to work hard.
Plain and simple.
He leaves nothing -- absolutely nothing -- to chance. Of course, this means he has to work relentlessly, and he starts to fret if he has any patients that aren’t discharged by the end of the day. He wants to see them safely transferred upstairs -- he’ll take them himself at this point -- or he’ll walk them out the front door himself, buckle them in their cars and wish them the best at home.
It’s a little over the top, and Will knows it.
But he also knows what it’s like to see so many patients die unexpectedly. One is the kind of crazy you can live with. The other -- well, it isn’t.
So now he doesn’t just work early and late. Now, he mostly works all the time. He cancels plans with Jay to stay late one night, not because he’s behind with charting -- he is, though -- but because there’s a patient here -- a 22 year old girl -- who is waiting on a bed upstairs in the cardiology ward. She’s got a persistent case of myocarditis, and it’s probably fine -- she’s probably fine -- but the thought of her sitting in the ED all night with his name on her chart?
Well, those aren’t odds he’d wish on anyone, especially not a 22 year old kid.
She wants to be a nurse, too. She’s in her final year of studies.
Will is determined to get her there.
Or, you know, upstairs at least.
He ends up staying the whole night, sleeping on the couch in the lounge, and when he wakes up, stiff and sore, he’s thrilled to find that she’s still alive. Better still, there’s a bed upstairs, and Emily is here, ready to facilitate the transfer.
“I can do it,” he says, ignoring the fact that he’s not had a good night’s sleep and he’s not showered or cleaned or eaten. “I’ll see her through.”
Emily gives him a quizzical look. “Your shift officially starts in an hour.”
“So?” Will asks.
“So,” Emily says. “You look like you’ll fall over if you don’t go eat something.”
He rolls his eyes. “It’s not that bad.”
“It might be worse,” she tells him. “Seriously, though. Go. Eat. You’ve stayed all night with her. You’ve done enough for that poor girl.”
“Poor girl?” Will asks. “She’s fine.”
“But have you talked to her about her family?” Emily asks. “Her mother is with another new boyfriend, and her father won’t talk to her. She watched her grandmother die from cancer several years ago, and just last spring, her grandfather died from COVID. Add that to the fact that she found out her boyfriend had been cheating on her. It’s amazing that she’s still functional at all.”
Will frowns. He’s taken a full and detailed history, and basically none of those points had come out -- outside the cancer and the COVID in the medical history.
He looks to the room where the patient is awake and alert. Alive.
She’s alive.
Will feels his stomach grumble. He glances to Emily. “All you have to do is wait for the transfer team. They’ll take her upstairs. That’s all.”
Emily smiles sweetly. “Don’t worry, Dr. Halstead,” she says. “I’ll take care of everything.”
-o-
Will knows he’s hungry, but he doesn’t realize just how hungry he is until he gets downstairs and orders himself his food. He eats one bagel, downs a cup of juice, and then goes back and orders again. This time, he goes for it with an egg sandwich and a strong cup of coffee. The food will fill his stomach to get him going, but there’s no chance of a good night’s sleep. Caffeine will have to suffice.
Even despite his lack of sleep, Will feels good. In fact, he feels really good. He’s starting to feel like maybe he can do this, that maybe today -- today! -- won’t be so bad.
That optimism lasts for approximately 30 minutes.
By the time he gets back upstairs, though, Crockett is coming out of his patient’s room. “Oh, is my patient transferred already?” Will asks.
Crockett looks at him, shaking his head. “I’m sorry, no,” he says. “I just ran the code.”
Will knows what Crockett is saying but he doesn’t know what Crockett is saying. Because he can’t be saying what he seems to be saying.
There’s no way.
“But she was stable,” Will says. “She was literally being transferred right now.”
He says this like it will make a difference, like he can will it into existence by virtue of his belief alone.
Crockett looks back at him, though. He sighs. “I’m sorry,” he says again, even more inexplicably than before. “I came in and her heart was stopped. We tried getting her back for ten minutes, but she was gone. There was nothing we could do.”
Will stops and stares. His mind reels, and he tries to parse the information in a way that makes sense to him.
She’s dead.
Will stayed all night with her and she’s dead.
She’d been young and eager, healthy and ready.
And now she’s dead.
He kind of wants to laugh. “But how did she die?” he wonders despite himself.
“Heart attack is my best guess,” Crockett says. “We’ll have pathology run an autopsy just to be sure.”
He says it simple, matter of fact. Like the pathology report will say anything other than Dr. Halstead is a reaper of death. That’s how it starting to feel.
Crockett slaps him upside the arm. “Tough break,” he says. “Sometimes, there’s just nothing you can do.”
That’s supposed to be that then.
Will’s patients keep dying.
And there's just nothing he can do about it at all.
-o-
To say Will is upset is something of an understatement. Somehow, he feels crushed inside, like the last of his hope has been fully and irrevocably extinguished. He’s not even sure how to make sense of it anymore, and his utility as a doctor seems entirely spent. He’d save more lives, he thinks, by not showing up to work at all.
He could be cursed, but that’s too easy. It’s probably his fault.
It’s got to be his fault.
How else can he explain it? How else can he make sense of it?
How else?
It’s a question with an answer.
But it’s an answer he’s not sure he’s ready to admit.
-o-
He makes it through his shift, somehow. He barely feels cognizant, but no one else dies. Emily seems to see how upset he is by this and backs off a bit, as if she recognizes his internal struggle with the inevitable reality that maybe he’s just not meant to be a doctor anymore.
Emily offers to talk -- she offers to listen -- but Will can’t think of anyway to say what he’s thinking anymore. He became a doctor to save people, but here he is.
Here he is.
He’s not saving people very much these days.
He’s starting to wonder if he’s actually much of a doctor at all.
-o-
Ethan notices.
Ethan’s been understandably distracted recently. As chief, he’s got a lot on his plate, and Will knows he’s struggling with things more than he lets on to the rest of the ED. His recovery hasn’t been a straight line, and that’s why Will’s tried to lighten the load. In his effort to ease Ethan’s burden, however, he’s worried that he’s become the biggest source of it.
He’s just not sure the other man realizes it yet.
Will knows by now how risky secrets are, and if he’s got concerns, he’s got to voice them. That’s going to be his only saving grace. He may be a horrible doctor these days, but his ethics are going to be spot on, and no one will be able to fault him for procedure.
So, he takes his boss -- his friend -- aside during a break and makes sure they are alone. Then, he confesses the truth.
“My patients are dying at an unusually high rate,” he says, putting it out there as simply as he can. “I’ve noticed it for several weeks now, and I’ve tried to trace a pattern -- something, anything -- and I don’t know what’s going on. I’ve reviewed the charts. I followed up with pathology. There are no red flags, but I know something’s wrong.”
It’s not an easy thing, telling someone that you feel like your medical skills are failing you for unexplainable reasons. The good news is that Will has little if any pride left, so he might as well put it all out there.
Will’s come prepared. He has his files printed out, and he has an aggregate of his data. Ethan takes it and skims it, but he doesn’t look surprised. “It’s been on our radar, too,” he admits. “And I’ve done what you’ve done. I’ve reviewed it. The numbers are weird -- I agree -- but I can’t find anything to fault.”
Will’s not about to take a pass, though. “A little weird? Ethan, it’s a lot weird,” he says. “This is double the rate of anyone else in the ED. And it’s been going on for a month straight.”
“But I’ve reviewed your charts,” Ethan reminds him. “You know I have to do that as part of your probation. And there’s nothing there. Most of those patients couldn’t have been saved. You’re not missing things. It’s bad luck. Massive blood loss, profound head injuries, acute strokes -- the stuff you can’t see coming. The stuff you can’t always fight.”
“Some of them, yes,” Will agrees. He gestures to the file again. “But at least once a week, someone dies who shouldn’t. Heart attacks that come out of nowhere. Unexpected heart failure. Inconclusive autopsy results. Once a week, Ethan.”
He sighs, clearly striving to be patient. “And that happens, too. Medicine is rarely black and white, no matter how much we’d like to think otherwise.”
Will allows himself a goggle. “But once a week?” he asks, incredulous. “You have a perfectly healthy patient on their way to a transfer or discharge who up and dies once a week?”
His point is made, and Ethan defers. “Are you doing anything strange?”
Will wishes it were that simple, honestly. A clear, simple answer would do him good right now, but all he has is the impossible ambiguity. “No,” he says, practically emphatic in his frustration. “I’ve been going over it in my head, trying to see if I’m lapsing on some protocol somewhere. But I clean my hands. I use fresh tools. I wipe down my iPad.”
“That wouldn’t even be the source,” Ethan points out. “I mean, your patients -- they’re not generally dying of infection.”
Will considers this, shrugging one shoulder. “I guess not. But that’s the problem. There’s no common thread.”
“That’s not a problem. That just reinforces what I said all along: this is probably random,” Ethan tells him.
Will can’t help but visibly deflate, and Ethan quickly follows up.
“But we’ll keep an eye on it,” he says, almost as an afterthought. “Both of us.”
“Would you?” Will asks, hopeful and relieved.
“Sure,” Ethan says. “I mean, I don’t have any doubts about your work, but it can hurt to doublecheck things.”
“Thanks,” Will says. “I don’t know what’s going on -- I can’t place it for the life of me. But something’s off. Something’s just not right.”
Ethan smiles, a little bemused. “You’re overthinking things, Will.”
Will has to chuckle. “Bet you never thought you’d say that.”
Ethan grins. “First for everything.”
-o-
So Will doublechecks.
Then, when that fails. He triple checks. He tracks everything -- every little detail, no matter how random. He creates his own supplemental charting system, documenting the nuances of his patient interactions.
This is when Will starts to notice the little things seemingly outside of his control. See, after his traumas are done, the rooms have to be cleaned and documented. There are a number of misplaced drugs in relation to his traumas with vials being found after the fact in the wrong place. There are also charting inconsistencies, he discovers, as he cross-references his patients. His notes are overlaid with those from the nurse, and the discrepancies are suddenly more telling than he’s remembered.
The amount of each dose is sometimes off. The timing of the dosages has been changed.
It’s almost always Emily.
Such small things are often overlooked in the chaotic ebb and flow of the ED, but as Will looks at the trend holistically, it’s startling. Emily’s not just missing a few steps. She seems to be operating on a whole different level.
Now, on some level, Will’s known this all along. But this isn’t her lackadaisical approach to procedures. It has nothing to do with her slow response time or her overly personable approach to patients. Her lack of precision in charting could just be sloppiness in her paperwork, but that’s the problem. Without accuracy there, there’s just no way to know.
He starts to watch her more closely. He corrects her more regularly. When he questions her choices, she laughs at him. “I have the right amounts in my head, don’t worry!” she says about the undocumented doses.
“There’s plenty of evidence to suggest that hospitals are too aggressive with their medication regimen. We have to let patients rest, you know?” she tells him when he asks about the timing of doses.
“I’m not a secretary, I’m a nurse!” she insists when he points out her inconsistencies on the charts.
There’s always an excuse.
Never an answer.
-o-
No answers, but more questions. If Will weren’t drowning in paperwork, he might have time to ask them all. As it is, he can barely keep his head afloat. With the number of inconsistencies he’s finding, his charting takes almost twice as long. In short, there’s just no time for it all, and Will’s been keeping his head above water for the last six months, but it’s pretty clear that his treading just isn’t good enough anymore.
To clarify: he’s not good enough anymore.
What’s worse, no one seems to notice. Maggie tells him how great he’s doing. Ethan is always thanking him. By all accounts, he’s doing great.
It figures, then, that the only person who sees him struggling is the one person at the heart of it: Emily.
She’s sweet, and she’s well-intentioned. She’s part of they team, whether anyone likes her or not, and Will’s still working to get her up to snuff. He’s the kind of guy who needs a thousand chances. He feels compelled to extend them to her in return since he knows how much she cares.
He likes to think that matters.
Will, of all people, has to think that matters.
And besides, even though he knows she’s part of his problem, he can’t exactly go blaming a nurse. He’s the doctor; the buck stops with him.
Besides, despite all of Emily’s shortcomings, she is really good at comfort.
Like really good.
It’s no wonder patients are drawn to her.
When she makes it all about you, it’s like you’re the center of the world. During hardships, that sort of attention can be everything.
He tries to deflect her -- to keep things professional -- but she’s pretty convincing.
And Will is pretty lonely.
“You can tell me,” she says, leaning on the counter across from him at the admit desk. “I can see that something is wrong.”
He has to scoff because his only other option is to cry. “What’s not wrong?” he admits. He lowers his voice and looks around. “The whole things a mess. My paperwork is a mess, and Ethan is looking at everything I do, and I’ve been so focused on the quality of my work that my quantity is way down. I’m not seeing as many patients, and my other numbers aren’t improving.”
In other words, it’s all going to pot.
“Well, that certainly sounds dire,” she muses toward him, still nonchalant.
He gives her a plaintive look. “Emily, I’m serious.”
“And so am I,” she says, growing a little more serious. “Worrying doesn’t make anything better. You have to focus on the relevant factors.”
“I am,” Will says. “The relevant factors are that my ability to take care of patients has diminished.”
“Your ability to chug them out like an assembly line, sure,” she says. “But that’s not why you’re a doctor. I’ve seen the quality of your care, and you’re the best. The numbers aren’t important.”
That’s a tempting out, a nice platitude, but it doesn’t hold much weight. “They are, though. They’re really important. It’s my ass on the line.”
At that, she frowns. “You really think they’ll fire you?” she asks. “Because of your probation?”
He sighs, pursing his lips a little uncomfortably. He looks down again, blindly studying his iPad. “Maybe,” he says. “But it’s more than that. It’s everything. My career. My whole life.”
She tilts her head to the side. “Your career is your whole life?” she asks, sounding skeptical.
He takes the note with a small dose of chagrin. “Well, not my whole life,” he clarifies. “But it’s a big part of it.”
She lifts her brows. “What about your hobbies?”
“Who has time for hobbies when I work 12 hour days?” he reminds her.
“Family,” she ventures next.
He sighs. “I have a brother, but he’s a cop. He’s busy, too.”
“Significant other?” she asks.
Will looks away once more, doing his best not to redden. “Not right now.”
She looks sorry for it, and she reaches out her hand to his. “I’m sorry. But I’m sure you’ll find someone.”
He pulls back, flustered now. “No -- I’m not--” he starts and has to stop while he shakes his head to get his head screwed back on right. “Look, this isn’t really appropriate. And besides, I don’t have time for it. I need to get back to work, and so do you.”
“Sure, sure,” she says, and somehow she sounds condescending. Her lips tip up into that little smile of hers. “You do that.”
“You do it, too,” he reminds her. “We’ve got a patient in three and another in five.”
She nods along. “I’ve got your back, Dr. Halstead,” she says. “You can count on me for that.”
It’s meant to be a comfort.
Moving away to his next patient, he’s not sure why it doesn’t feel like one.
-o-
There’s no time to think about it, anyway. He can’t think about Emily.
Not when his patients are still in such a precarious position.
Not when he is in such a precarious position. He needs solutions, not more problems. He needs to find a pattern, a lapse, a weakness: anything.
He doesn’t have time to look at half competent nurses anymore.
Will knows his priorities after all this time.
-o-
Now, Sharon is not a naive sort of woman. She understands her job, and she understands its complexities. You don’t go into medicine expecting clear cut answers and simple solutions. And you sure as hell don’t go into management if you want things to be easy.
So, she expects complication. She’s fully prepared for all sorts of obstacles and trials. She’s trained for all of it, and she knows how to face it with poise, grace and determination.
Pandemics? Sure. She’ll come up with innovative protocols to keep them operational even during the worst of times.
Staffing shortages? Okay. She’ll handle the time management and approve transfers to make sure that everything stays staffed and functional, and the hospital doors stay open.
Doctors stealing trial meds? She has to admit, that was a new one, but she dealt with it as well as could be expected. She’s even gotten Kender to start returning her phone calls, so there’s hope that maybe it won’t have a permanent impact on Gaffney’s bottom line.
It’s just, this death rate thing.
It’s not that it’s never happened before. They’ve had spikes before. They’ve had negative trends. Once, a few years back, Sharon had managed to unearth a source of contaminated surgical gear that led to a series of infections. She’s tracked MRSA outbreaks. She’s fired nurses for lapses in cleaning.
Death rates change.
Sharon has always changed to combat it.
She’s always, always fixed the problem.
But this one, admittedly, has her flummoxed.
She goes out of her way to do additional data collection. She runs tests on their suppliers, looking for any notable changes. She checks the admission procedures in the ED, and evaluates them for any recent lapses or alterations.
There’s nothing, though.
There’s absolutely nothing.
In truth, that’s good news. It means all the policies and procedures are in place and working. It doesn’t, however, explain why patients are dying.
Why Dr. Halstead’s patients in particular are dying.
At a certain point, she feels like she’s fighting the inevitable. There’s something to be said for Occam’s Razor, she fears, and she doesn’t want to stand in the face of the obvious and keep looking for something else.
The problem is the obvious isn’t obvious at all.
What does it even mean? It’s not like Dr. Halstead is murdering his patients. That’s absolutely asinine to even think about. Dr. Halstead has many flaws, but he’s a good doctor who cares about his patients. In fact, his desire to keep patients alive is often what gets him into trouble. He’ll cut corners -- but only to improve patient outcomes.
Therefore, any lapse from him would not seem to be linked to negative outcomes. That’s just not who he is.
But each piece of evidence she gathers is just as telling as the last.
Normally, she’d launch a formal review and just be done with it. But the hospital’s in a precarious position. Money is tight; publicity isn’t great. They can’t afford too many more hits in the newspapers, and something like this death rate problem would certainly make waves. It could spook shaky donors, and they’re only a few donations away from having to close a department.
Plus, an investigation alone will probably end Dr. Halstead’s career. On probation for serious missteps already, the board won’t care for nuance. Dr. Halstead has essentially struck out already. The only reason he’s had any reprieve is because Sharon has vouched for him and the hospital is so short staffed that you might call them desperate.
Desperate seems like an apt word these days. More and more as Sharon looks at the numbers.
She’ll have to make a call at some point.
She just likes to hope it won’t be today.
-o-
Today, maybe not, but two days later, Sharon gets another call from Gwen.
They’ve gone several weeks without any actual contact, and those several weeks have been lovely as far as Sharon is concerned. Tensions have eased between them ever since the mess with the new ED nurse was sorted out, and their last interaction had been nearly pleasant. She is still waiting for final budget approval, but of all the things falling apart in Sharon’s hospital, she has found comfort in the idea that at least that relationship is in an acceptable holding pattern.
Until, of course, it isn’t.
This time, when Gwen calls, she sounds a lot less pleasant.
She sounds angry, just two shades shy of pissed off.
“I just got told about the latest ED numbers,” she says.
Sharon decides to play dumb. She has her suspicions, but she doesn’t want to overplay her hand here. “Which numbers are those?”
Most of the numbers are, after all, very good.
Naturally, that’s why Gwen is talking about the ones that aren’t. “The death rate,” she says, and at least she’s not brokering anything here. Her annoyance is genuine, Sharon has no doubt. “The death rate in the ED has doubled in the last three months?”
Sharon draws a breath, because she knows this already. It is as dramatic as Gwen makes it sound, but the last thing she needs is to make decisions based in emotion when the stakes are precisely this high. “We should put this in context,” she says. “Our death rate was very low to begin with, and when you’re talking about numbers--”
“Spare me the introduction to statistics. I did take those classes in school, thank you,” Gwen says sharply. “Explain to me what is happening and how you intend to fix it?”
As if this hasn’t been her preoccupying thought for a week straight now. “I assure you, I am currently investigating this from all angles--”
“But there’s no formal investigation,” Gwen snaps.
“Right now the data is too raw, and we need more corroborating information--”
She’s been reasonable and concise, which is exactly what Gwen likes. Except that Gwen doesn’t like what she’s saying, and Gwen is used to getting exactly what she wants. “I don’t want excuses, Sharon,” she says. “I want answers. More than that, I want results. I want an ED that isn’t killing people. I don’t really think that’s too much to ask for one of the top hospitals in the entire Midwest.”
Gwen is somewhat past the point of reason right now, so Sharon goes for conciliatory. “I want answers just as much as you do--”
“No, I’m not sure you actually do,” Gwen says. “In fact, I’m not sure you want anything you say you want. Remember that x-ray machine you’ve wanted?”
The one Gwen has been fast tracking for them since the new nurse was hired?
Gwen huffs audibly over the line. “I’m starting to think it might be better served in another department,” she says. “You know, one that isn’t killing its patients.”
It’s not that Sharon is surprised -- she’s not -- but the whole of the situation is one that she is going to have limited patience for. Because, the stakes are big here, and Gwen it playing petty. “Are you really going to try to blackmail me with ED death rates?”
She should know better than to try to guilt someone like Gwen. Gwen can’t be guilted into anything. “I’m just telling you the facts,” she replies. “Find the problem and fix it, Sharon. Or I will fix it myself, gutting your precious ED and firing every staff member including yourself. Am I making myself clear?”
Sharon holds her tongue, flattens her mouth. “Perfectly.”
Because nothing else was clear right now.
But that threat?
Was pretty easy to understand.
-o-
Will’s actually not known for his ability to persevere. He knows how to be successful, but he’s the kind of guy who starts strong and then cuts and runs when things get hard. Moving back to Chicago, making peace with Jay and his dad, finding a place at Med -- it had changed things. Will had allowed himself to believe he could persevere.
Well, it’s not the first thing he’s been wrong about, to be sure. Sometimes, it kind of feels like the last, though.
See, perseverance is supposed to be easy in concept. It’s about getting through things. It’s as simple as showing up day after day and believing that things will get better eventually.
Except, they’re not getting better.
Will’s patients just keep dying.
He’s filled out more death certificates than release forms, it seems like. That may not be true, but at this point, Will honestly can’t figure it out. It’s too many. It’s too much.
Will’s been through a lot over the last few years. He’s been coerced into an undercover operation as a CI, which nearly led to his murder and resulted in the breakup of his engagement on his wedding day. He’d been forced into witness protection for several months, and he came back racked with PTSD to the point where he alienated everyone who might have still cared about him.
After a car accident, the rest of his life had bottomed out. Trying to rebuild, he’d gotten involved with an illegal safe injection site and then fell in love with a drug addict. During a pandemic, where he had to work on the front lines, he hastily moved in with said drug addict and their relationship imploded.
Breaking up with her was necessary, and Will floundered. He got passed up on a promotion that should have been his, and he spent a year flirting with the idea of leaving emergency medicine altogether just because it felt good to be wanted. However, he’d botched that opportunity just like he’d botched his career at Med. He’d also botched his relationship with Sabeena and Natalie simultaneously, and now Will was barely employed, disgraced and alone.
And this? Right now?
This is somehow worse than all of that.
He can’t get away from it, no matter what he does.
He can’t get away from her.
He knows it’s not fair to associate all this with her -- necessarily. She’s just a nurse. A little odd, well intentioned and poorly equipped for life in the ED. But it’s not like this is really her fault.
It’s just that every time he turns out -- it’s Emily.
Every time he’s doing paper -- it’s Emily.
Every time he goes into a patient room -- it’s Emily.
Every time he calls time of death -- it’s Emily.
Funny enough, the death procedures are the only ones he can count on her to do promptly.
Every time.
Every.
Time.
It’s Emily.
-o-
There’s no one he can talk to at work -- not really. Ethan wants to hear good reports, and Maggie just doesn’t know enough to do anything. Will’s trying to keep the fragile balance in check there, because he knows that the ED is barely making it work as it is.
He finds respite, his only respite, with his brother.
It’s hard to find time to meet with Jay these days. His brother’s schedule is crazy, and he’s got his relationship with Hailey to figure out. When paired with Will’s increased workload, there just isn’t much time to socialize.
Besides, Will’s pretty sure he’s bad company these days. Jay is going to regret ever telling Will to see things through in Chicago.
But they’re here. That’s as much as Will can offer these days. He’s here.
“You’re working too much,” Jay cajoles. They’re sitting at a table at the back of the bar, watching while the raucous scene unfolds in front of them. Will barely remembers what that’s like, people being happy and living their lives. Couples snuggling in a booth. Friends joking at the bar. Fans cheering at the game on the TV while a pair of buddies start up a pool game.
Jay snaps his fingers at Will, bringing his attention back around.
“Too much,” he says, repeating the words and giving them extra emphasis. “It’s not good for you.”
Will sighs, and he can’t exactly deny it. “Probably, but I don’t know what else to do. I can’t risk my job while on probation.”
It’s a well worn response that Jay’s heard before, and he seems a bit exasperated. “That’s been the card Goodwin’s played for months now. Isn’t it about time they resolved it?”
“That’s not for me to say,” Will says. “I’m the one who screwed up. I’m the one taking responsibility.”
“I know, I know, and I’m all for it -- usually,” Jay says. “But I think they’re taking advantage of you a little bit.”
Will can only shrug. “Even so, I deserve it.”
Jay gives him a look. “You covered up Natalie’s crime -- it’s not like you killed someone.”
At that, Will scoffs. It’s more raw than he’s perhaps let himself realize. “I’m not sure that’s true,” he finally admitted with a touch of ruefulness. “I’m on a bad run.”
They have different lines of work, and the idea of a bad run can mean very different things to them. Jay’s not stupid, though, and they both work in high stakes industries. It’s not just a sales quota. It’s not the bottom line. It’s lives.
“It happens,” Jay says, even as he looks mildly disconcerted. “We all have them.”
Will looks at his drink and makes a face. “Sure, we do. But this one? I’ve never had one like this before.”
Jay gives Will an expression of incredulity. “You’re probably just obsessing over it so it seems more. When you’re working under a microscope, it feels like small things are a big deal.”
“It’s not that,” Will protests. “I mean, not really. I haven’t sat down to actually run the numbers, but it feels like I’m sending more people to the morgue than home. And not just like I’m getting the patients who are most bad off. I’m losing people who were stable. People I was prepping discharge paperwork for.”
“But stuff happens,” Jay points out. “You tell me that all the time.”
It’s true; it has been one of Will’s favorite defenses in the past. It feels woefully insufficient these days. Will has to shake his head. “This just feels different.”
It’s a vague sort of determination, but Will is steadfast in it nonetheless.
Jay, though, is steadfast, too. Probably more than Will, over the long haul. “It’s just a funk, man,” he says, making a small face of indifference. “You’ll get out of it.”
It’s the perseverance mindset, the one that Will has tried so hard at and failed so spectacularly with. Still, about the only thing he’s doing right is keeping things level with his brother. When the rest of his life is on the verge of total collapse, he’s not especially keen to ruin that. “I guess,” he finally agrees with a noncommittal shrug.
If Will is trying to sound reassuring, though, he’s failing at that as well. Jay sits forward, beer pushed aside and gives Will a more plaintive once over. “Look, does anyone else have anything to say about this? Has anyone else even commented?”
That’s a point, and Will knows it. He’s still reluctant to concede it. “No,” he says. “But it’s not like we go reviewing each other’s cases. I talked to Maggie about it, though.”
Jay raises his eyebrows, ever expectant. “And?”
Will exhales, somewhat begrudgingly. “And she agrees with you. She thinks I’m reading too much into things.”
Jay’s look is overtly I-told-you-so. “And no one else?”
“Well, Emily thinks it’s no big deal, but I’m not sure she counts,” Will explains.
Jay’s brow creases. “Emily?”
“The new nurse. She just started a few months ago, but she works with me a lot,” Will explains. “So she has a first hand view of it all. My patients are all her patients for the most part.”
“And is she worried?” Jay asks.
Will sighs, feeling exasperated at this point. “No. But she’s -- I don’t know. Different.”
Jay tilts his head. “Different?” he clarifies. His eyes narrow. “Do you like her?”
Will groans. “No, just -- no,” he says. “If anything, she’s difficult to have around. She’s not nearly as intuitive in the ED as most of the other nurses.”
Jay sits back, as if Will has just said something insightful. “Well, there you go.”
Will shakes his head, confused. “There what goes?”
Jay gestures forward. “Maybe it’s her,” he says. “Maybe she’s your problem.”
It’s a ridiculous notion, and Will finds himself recoiling. “Emily? What? Like she’s jinxed or something.”
“Or something,” Jay says, and he shrugs. “I don’t know, man. But if something’s off, you look for the thing that’s different. Sounds like this Emily person lines up with your bad streak. So, that may be more than you think it is.”
“Or it may be nothing, except I’m a bad doctor,” Will shoots back.
Jay rolls his eyes. “Whatever,” he says. “I’m just saying. Start with the obvious, bro. You have to start with the obvious.”
-o-
They don’t make a late night of it -- the Halstead boys aren’t as young as the used to be, after all -- and Will isn’t really much company. He perks up a little, with plenty of cajoling from Jay, but he’s more than a little relieved when Jay calls it quits before 10.
He makes his way home, and he knows how tired he is, but he also knows that sleep isn’t going to fix his problems. He sits on the bed for a little bit, thinking about his patients that day. He thinks about Mr. Garside.
Emily is undoubtedly a commonality between all these things, but it seems presumptuous to consider her the cause. Doesn’t it?
Because Will can’t be passing the buck. He’s the one on probation. He’s the one with his ass on the line. This is his responsibility. His.
Which is, of course, why he can’t let it go.
He just can’t. He thinks about the patients, he thinks about the cases, he thinks about the number of times he’s gone to a waiting room and told someone that he’s so very sorry.
Is he messing up his medication doses?
Is he failing to take the patient history into consideration?
Is he just not doing his due diligence? Is he messing up on his diagnostics?
Or is he missing the obvious?
Will’s been on probation for months now. He’s worked at Med even longer than that. He’d been a doctor for a decade. He knows what he’s capable of, and all mistakes aside, he’s never doubted his ability to run a proper diagnostic. Even after being fired and then rehired, his performance has been good. It’s been more than good. It’s been impeccable.
What’s changed, then?
Jay’s right. There is just one thing. And it’s a nurse who doesn’t fit into the ED at all. He’s always frustrated with Emily, the way she never does what he needs and the way she has to be reminded to do basic tasks. She works contrary to him nine times out of ten.
It could be her.
Not intentionally, of course, but the lapses are real. No matter how much Will works to compensate for her, it’s her performance that he knows is lacking. And in all of that, from her skewed focused to his scattered attention, it could be compromising the care of patients.
Will knows how much it matters for him to handle this. He knows that keeping the ED running smooth is what Ethan needs from him. But this is about more than Will’s pride now. This is about saving patients, saving lives. He needs to talk to Ethan about Emily.
No one else should have to die.
-o-
It’s not a fun topic to bring up, even among ED docs who have seen the worst. Will knows he’s putting himself in a vulnerable position -- both admitting that his death rate has been unusually high and that he’s failed to help Emily adjust -- but secrets don’t work for him. Never have, never will. Honesty is about the only thing he’s got left going for him.
It’s about time to embrace it.
Better late than never.
When he broaches the subject, Ethan doesn’t look surprised. Will is not sure if he’s relieved or worried that his patient care has been the topic of some inside debate among the administration.
“It’s just between Ms. Goodwin and myself for the time being -- and maybe one of the data analysts,” Ethan says, and he is making some effort to sound consoling.
Will is not particularly consoled, however.
“Well, I’m not bringing it up just to bring it up,” Will says, trying to keep himself on track here. “But obviously, it’s been on my mind a lot.”
“Mine, too,” Ethan says. “I’ve been watching you closely, and I do review your charts. Nothing jumps out at me.”
“Me neither,” Will says. “I’ve gone over everything, and you better believe I’ve started putting extra thought into everything I do. I can’t find a single thing that's different -- except one.”
Will is hesitating, and Ethan looks eager. “Oh?”
Will sighs, and knows he has to just say it. “The shift coincides almost perfectly with when I started working with Emily.”
That’s not the answer Ethan’s expecting. And, why should it be? Will is going out of his way to bring attention to the performance of another staff member, a staff member who has, effectively, been under his supervision. That makes him uniquely qualified to see her mistakes, sure. But it also puts him in an unusual position of responsibility. He might as well be confessing to his own incompetence.
Ethan does appear somewhat distressed by this. “You think it’s Emily?”
“I don’t think it’s necessarily Emily, but she’s not exactly fully adapted to the ED,” he says. “I’ve been trying for months now, hoping to get her up to speed, but she just doesn’t work the same way as the other nurses. That’s why no one can seem to get her off my cases. She just doesn’t fit anywhere else.”
“I thought that was a good thing,” Ethan says, still concerned. “By pairing you two up, it’s helped streamline ED production.”
“But look at my cases with her compared to my cases with other nurses,” he says. “It’s dramatically different.”
“The comparison size is too small--”
Will nods, eager to make this point. “And isn’t that part of the problem? The nurses are rotated, and with good reason. I think it’s possible we’ve created our own problem here. She’s getting to set in patterns -- I’m getting too set in patterns -- and it’s causing lapses. I don’t know how, I don’t know where yet -- but something about her is the source of this.”
At that, Ethan’s expression shifts from concerned to grave.
“We all have our own methods, and I admit, some of hers could be different,” Ethan says. “But her results are clear; patients love her. She gets the highest marks on patient exit surveys -- way better than Doris, even better than Maggie.”
“Patients love her, but none of the nurses do,” Will says. “And as one of the primary doctors who has worked with her, I can’t say she’s exactly on par with the other nurses. This isn’t all about who can hold a patient’s hand. It’s about the quality of care we’re providing.”
Ethan makes a face, as though this is somewhat exasperating for him. “She’s still new. And it’s no surprise that her priority for patient care somewhat impedes her connection with compliance issues. Besides, that’s really been your charge, isn’t it? To get her integrated?”
Will is feeling increasingly incredulous. “But Ethan, this is your ED. Compliance, policies, procedures -- I’ve taken all that to heart, and I’m telling you. There’s something off about Emily. She’s not picking it up. Any of it.”
“But I’ve learned the hard way that sometimes you have to lighten up, have some give,” Ethan reasons. “And you know how paperwork is. Inconsistencies happen. It’s not a crime or some kind of conspiracy. Sometimes it’s stylistic. Sometimes you just have to learn the ropes.”
This sounds reasonable, and maybe it is reasonable on the surface. But Will knows his patients. He knows his own practice of medicine.
And he knows that something is wrong.
He’s examined his own choices first, but this time, he’s come up blank. This time, all he’s got is this.
“Ethan, please,” Will says. “I’ve gone over every case. I’ve evaluated every procedure. Emily is the only thing I can find that’s different for me lately -- and she’s the only consistent factor with every case I pulled.”
Ethan sighs. “Will--”
“I’m not saying it’s nefarious. I’m not even saying it’s bad or intentional or whatever,” Will says. “But if she’s not got our procedures down, then she could be failing in more ways we haven’t realized yet. And I know better than anyone how letting a few things slide can make the whole thing collapse. We have to look into it. For the sake of our ED patients.”
To this suggestion, Ethan’s expression is grim. “Will, I know you’re stressed out--”
He shakes his head. “That’s not what this is--”
“And I know you want to prove yourself--”
“Ethan, I swear to you, that’s not what this is,” Will says again, even more insistent. “I know it seems like I’m trying to pass the buck, but the opposite is true. I just want the truth -- for my patients and this ED.”
With a long, slow breath, Ethan remains unconvinced. “You say that, but you’re standing here with a stack of dead patients, telling me how you want to blame your nurse. Not just any nurse. A new nurse without any credibility built up. It looks like you’ve picked the easiest target, but you’re forgetting that you’re the one on probation, Will. I’ve been on your side throughout this process, but we can’t be naive, and you can’t afford to go around making accusations you can’t back up.”
“I know that,” Will says, because he does. He does know that. He just doesn’t know what else to do at this point. “But Ethan, my patients keep dying. One or two -- yeah, that happens. But I’ve lost track now. Patients I thought would live -- keep ending up dead. There has to be a reason.”
“Okay,” Ethan says, and he’s clearly trying to be patient. “But you’re emotionally attached to this. That doesn’t make you unbiased here.”
That answer is moderately infuriating. “I know,” he says. “But it also means I’m motivated to figure this out, and it seems like I’m the only one. I’ve been over all these case files. I’ve gone over my own procedures in my head. And I can’t find anything except Emily.”
He’s getting worked up, and he knows it. There’s a part of him that recognizes that his emotion is making him less credible, but he can’t stop himself.
He just can’t.
He’s supposed to be picking and choosing his battles, but if saving his patients isn’t the stand he’s supposed to take, then he’s not sure what is.
“Okay, okay,” Ethan says, clearly placating him now. “I know you’re upset, but you need to calm down.”
Ethan’s trying to be reasonable, but Will’s about five dead patients past reasonable. He shakes his head. “I can’t.”
“But you have to,” Ethan says, and he leans forward. “Will, I’m on your side, but not everyone is. You have to be careful.”
Will frowns. “That’s exactly what I’m being,” he argues. “That’s why I’ve scoured my case files for anything.”
“And you come up with blame the nurse?” Ethan asks.
“Ethan--”
“Will, just -- listen,” Ethan says. “Keep your eye on her, okay? Double check her work -- and yours. If you can come up with more concrete evidence, I’ll take it to Goodwin and run with it. But until then, you’ve got to keep your head down.”
Will leans back from him, feeling stiff. “And if my patients keep dying anyway?”
Ethan shrugs grimly. “You better hope they don’t.”
Will knows he doesn’t deserve solace, given the position he’s in.
But that’s the coldest comfort yet.
-o-
Sharon gets a lot of messages. She listens to them all, and she gives them all her equal attention. That’s just part of the job.
That doesn’t mean she likes them all the same.
Or that she responds to them all with the same vigor.
Such is the case when Gwen leaves her a voicemail.
Which, of course Gwen does. Gwen is not a hands-on administrator in some ways. She’s not hanging out in the ED or doing ride alongs in the OR, as it were. But Gwen likes an immediacy in her interactions, she’s a smart enough woman to know that a line of text isn’t going to carry the same weight as an actual voice.
Gwen wants Sharon to hear her, in a very literal fashion. That makes context easier to understand. When she’s happy, it’s easy to tell. When she’s worried, that’s easy, too. And, of course, when she’s pissed off, that translates very easily into her tone. She suspects Gwen likes to think the sound of her voice will be a motivating factor of some sorts.
As if that’s going to scare her.
It doesn’t scare her.
But it gives her context for just what kind of day this is going to be.
Most of the message is benign as Gwen runs down the list of things to talk about at their next meeting. She wants refreshed and in-depth departmental reviews, see. She disapproves of the progress being made in cardio -- after losing Dr. Downey and Dr. Rhodes, they’ve never quite recovered -- and Gwen is about ready to recommend firing everyone who works in radiology if their performance records don’t seriously improve. Sharon doesn’t necessarily disagree with that; there’s been some issues, especially with surprise billing, down in that department. She’s a bit weary of going over it again and again, and in truth, she might side with Gwen this time if push comes to shove.
Oh, Gwen adds at the end of the call, she also wants to talk about the ED. She’s seen the numbers lately. And they seem weird. Do they seem weird to Sharon, too?
She’s not angry about that.
Sharon suspects she will be when she realizes just how much Sharon has noticed these days.
-o-
And for once, her interaction with Gwen is not the downfall of her day. Instead, the curious part happens later, during a meeting with Peter, the hospital’s main lawyer. They go over the basics, and he hems and haws before Sharon asks him what he really wants to talk about.
“It’s a little delicate, I’m afraid, and I’m just not sure who to talk to,” Peter admits, looking moderately disconcerted. “It concerns the board, but that’s really the problem. I’m not sure I’d get unbiased feedback.”
Peter’s hesitation is telling, but he’s scant on details. “Okay,” she says. “What’s it about?”
“A donor,” he supplies, a little relieved at the opportunity to go into some detail. “I’m starting to have a few concerns.”
“Okay,” Sharon says, because donor relations do fall within her purview. “Which one are we talking about?”
“Well, I can’t really say,” Peter says. “Not without making this legally more complicated.”
Sharon smirks a little, but the deflection is no surprise from Peter. “Well, then you know I can’t help you all that much.”
He seems to be uncertain about what to say next. “It’s just -- the money, see?” Peter posits. “It’s flagged for the ED.”
Sharon shrugs, somewhat indifferent to that particular revelation. “And how is that a problem? Money is flagged for certain departments and purposes all the time.”
“Of course,” Peter agrees. “But I always go over every donation, just to make sure the legal groundwork is solid, you know? I want to make sure we’re not leaving anything undone or unchecked. With donations of this size, the IRS really tends to want to make sure that nothing’s been missed.”
“Sure,” Sharon says, for that much is clearly evident. “And is there a problem with the paperwork?”
He makes a face, hedging even worse than before. “Not exactly,” he says. “It just seems -- I don’t know how to put it. It seems less than developed. Like, all the boxes are checked, but none of the details are filled out.”
Sharon lets a frown deepen on her face. “Can’t you go back and ask for more details?”
“With donors like this? You don’t want to be burdensome,” Peter says. “And I’m not sure if I’m overreacting. I think technically it’s all above board, but if there’s any kind of review or audit, I’m almost positive this donation will be flagged.”
That sounds somewhat ominous, but Sharon finds herself even more bothered by Peter’s reticence here. Peter’s good with the legal framing of things, but he’s not usually so keen to keep his cards this close to his chest. He is worried here. “Peter, I want to help you, but you will have to be more specific. Who are we talking about? If you don’t tell me, then my feedback isn’t going to mean much.”
“I know, I know,” Peter says quickly, almost sounding guilty. He shakes his head. “It’s just weird.”
“Then, maybe you should talk to the board,” Sharon offers as another way out.
But Peter quickly shakes his head again, this time more vigorously. “I can’t,” he says. “The board already approved it, no questions asked.”
This doesn’t make much sense. “What do you mean?”
Peter clarifies. “All clearance came from the board already. Their highest approval,” he says. “The file they gave me to clear? Was redacted by Gwen herself.”
Finally, the implications are clearer. Peter’s worried, but officially he has no grounds for it. He’s between a legal rock and a hierarchical hard place. “Oh,” she says now. “So this is the big stuff we’re talking about.”
Peter nods readily, somewhat relieved for her to understand his predicament. “It is.”
“And you’re afraid to question it,” Sharon presumes.
“I’m afraid of giving her the wrong idea with questions,” Peter says. “Questions she may very well have the answers to, but I don’t know because so many details have been omitted.”
She can appreciate his precarious position, if only because it’s one she’s been in before. They walk a delicate line; they do a careful dance. The margin between success and failure is slim at the level they work at, and they are both keenly aware of their own position. “Well, Peter, I’ve got my own problems,” Sharon commiserates.
He frowns, focus suddenly shifting. “Anything legal?”
Sharon has to chuckle, but it’s a dark sound. “I hope not. Just some performance issues, I think.”
He still looks disconcerted. “That sounds potentially legal.”
Sharon shrugs, but she doesn’t outright disagree. “Probably an HR issue first,” she says. “But I’m going to see if I can nip it in the bud myself.”
“Let’s hope,” he says, gathering his things. “Because I’ve got enough on my plate.”
“If you need more help with the donor issue--”
Peter smiles at her, but the look is dismissive. “We’ll all just do what we can, right?” he says. “And hope like hell it doesn’t blow up in our face.”
Sharon smiles sympathetically. “That’s not the most optimistic take.”
Peter shrugs, somewhat helplessly. “Tell me I’ve got a reason for optimism.”
Sharon sighs and nods to the door. “When I find some, I’ll let you know.”
“Good luck, Sharon,” Peter says with just a touch of grimness on his way out. “Somehow I feel like we’ll all be needing it.”
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
Will thinks if he just works harder. If he just puts in more effort. If he just pays closer attention. He memorizes the policies. He masters all the procedural elements to the ED. He spends every second of every day fully invested in his work. He’s taken to giving patients his full and undivided attention. He stays for more procedures. He transfers them to other wings himself. He’s done taking chances.
He won’t take a beating heart for granted ever again.
Not that it matters.
The more he cares, the harder he works -- the worse it gets. They just keep dying. From big things. From little things. Will always comes in when they’re crashing, and he’s just in time to run the code. He makes nice with Nina again down in pathology, and he starts checking up on every autopsy just to see. She smiles at him apologetically -- bygones have been bygones, and she’s married now -- and tells him that it’s natural causes.
“It happens,” she says. “I see it all day, every day.”
“But so many of them are my patients,” Will says, feeling bereft over the latest. A 50 year old woman -- a school teacher. She survived cancer and covid, but here she is, dead after cutting herself with a knife while chopping vegetables for dinner.
She’s supposed to take her kid to a soccer tournament this weekend.
“Will, there have been no red flags,” Nina says, and she stops what she is doing to look at him. “It’s just a lot of bad luck.”
-o-
Bad luck seems like a copout. It is a copout, and Will should know. It’s one he’s tried to use for years. But he’s in a new era of responsibility. It doesn’t fly. He can’t let it fly.
So if his luck is bad, he has to work hard.
Plain and simple.
He leaves nothing -- absolutely nothing -- to chance. Of course, this means he has to work relentlessly, and he starts to fret if he has any patients that aren’t discharged by the end of the day. He wants to see them safely transferred upstairs -- he’ll take them himself at this point -- or he’ll walk them out the front door himself, buckle them in their cars and wish them the best at home.
It’s a little over the top, and Will knows it.
But he also knows what it’s like to see so many patients die unexpectedly. One is the kind of crazy you can live with. The other -- well, it isn’t.
So now he doesn’t just work early and late. Now, he mostly works all the time. He cancels plans with Jay to stay late one night, not because he’s behind with charting -- he is, though -- but because there’s a patient here -- a 22 year old girl -- who is waiting on a bed upstairs in the cardiology ward. She’s got a persistent case of myocarditis, and it’s probably fine -- she’s probably fine -- but the thought of her sitting in the ED all night with his name on her chart?
Well, those aren’t odds he’d wish on anyone, especially not a 22 year old kid.
She wants to be a nurse, too. She’s in her final year of studies.
Will is determined to get her there.
Or, you know, upstairs at least.
He ends up staying the whole night, sleeping on the couch in the lounge, and when he wakes up, stiff and sore, he’s thrilled to find that she’s still alive. Better still, there’s a bed upstairs, and Emily is here, ready to facilitate the transfer.
“I can do it,” he says, ignoring the fact that he’s not had a good night’s sleep and he’s not showered or cleaned or eaten. “I’ll see her through.”
Emily gives him a quizzical look. “Your shift officially starts in an hour.”
“So?” Will asks.
“So,” Emily says. “You look like you’ll fall over if you don’t go eat something.”
He rolls his eyes. “It’s not that bad.”
“It might be worse,” she tells him. “Seriously, though. Go. Eat. You’ve stayed all night with her. You’ve done enough for that poor girl.”
“Poor girl?” Will asks. “She’s fine.”
“But have you talked to her about her family?” Emily asks. “Her mother is with another new boyfriend, and her father won’t talk to her. She watched her grandmother die from cancer several years ago, and just last spring, her grandfather died from COVID. Add that to the fact that she found out her boyfriend had been cheating on her. It’s amazing that she’s still functional at all.”
Will frowns. He’s taken a full and detailed history, and basically none of those points had come out -- outside the cancer and the COVID in the medical history.
He looks to the room where the patient is awake and alert. Alive.
She’s alive.
Will feels his stomach grumble. He glances to Emily. “All you have to do is wait for the transfer team. They’ll take her upstairs. That’s all.”
Emily smiles sweetly. “Don’t worry, Dr. Halstead,” she says. “I’ll take care of everything.”
-o-
Will knows he’s hungry, but he doesn’t realize just how hungry he is until he gets downstairs and orders himself his food. He eats one bagel, downs a cup of juice, and then goes back and orders again. This time, he goes for it with an egg sandwich and a strong cup of coffee. The food will fill his stomach to get him going, but there’s no chance of a good night’s sleep. Caffeine will have to suffice.
Even despite his lack of sleep, Will feels good. In fact, he feels really good. He’s starting to feel like maybe he can do this, that maybe today -- today! -- won’t be so bad.
That optimism lasts for approximately 30 minutes.
By the time he gets back upstairs, though, Crockett is coming out of his patient’s room. “Oh, is my patient transferred already?” Will asks.
Crockett looks at him, shaking his head. “I’m sorry, no,” he says. “I just ran the code.”
Will knows what Crockett is saying but he doesn’t know what Crockett is saying. Because he can’t be saying what he seems to be saying.
There’s no way.
“But she was stable,” Will says. “She was literally being transferred right now.”
He says this like it will make a difference, like he can will it into existence by virtue of his belief alone.
Crockett looks back at him, though. He sighs. “I’m sorry,” he says again, even more inexplicably than before. “I came in and her heart was stopped. We tried getting her back for ten minutes, but she was gone. There was nothing we could do.”
Will stops and stares. His mind reels, and he tries to parse the information in a way that makes sense to him.
She’s dead.
Will stayed all night with her and she’s dead.
She’d been young and eager, healthy and ready.
And now she’s dead.
He kind of wants to laugh. “But how did she die?” he wonders despite himself.
“Heart attack is my best guess,” Crockett says. “We’ll have pathology run an autopsy just to be sure.”
He says it simple, matter of fact. Like the pathology report will say anything other than Dr. Halstead is a reaper of death. That’s how it starting to feel.
Crockett slaps him upside the arm. “Tough break,” he says. “Sometimes, there’s just nothing you can do.”
That’s supposed to be that then.
Will’s patients keep dying.
And there's just nothing he can do about it at all.
-o-
To say Will is upset is something of an understatement. Somehow, he feels crushed inside, like the last of his hope has been fully and irrevocably extinguished. He’s not even sure how to make sense of it anymore, and his utility as a doctor seems entirely spent. He’d save more lives, he thinks, by not showing up to work at all.
He could be cursed, but that’s too easy. It’s probably his fault.
It’s got to be his fault.
How else can he explain it? How else can he make sense of it?
How else?
It’s a question with an answer.
But it’s an answer he’s not sure he’s ready to admit.
-o-
He makes it through his shift, somehow. He barely feels cognizant, but no one else dies. Emily seems to see how upset he is by this and backs off a bit, as if she recognizes his internal struggle with the inevitable reality that maybe he’s just not meant to be a doctor anymore.
Emily offers to talk -- she offers to listen -- but Will can’t think of anyway to say what he’s thinking anymore. He became a doctor to save people, but here he is.
Here he is.
He’s not saving people very much these days.
He’s starting to wonder if he’s actually much of a doctor at all.
-o-
Ethan notices.
Ethan’s been understandably distracted recently. As chief, he’s got a lot on his plate, and Will knows he’s struggling with things more than he lets on to the rest of the ED. His recovery hasn’t been a straight line, and that’s why Will’s tried to lighten the load. In his effort to ease Ethan’s burden, however, he’s worried that he’s become the biggest source of it.
He’s just not sure the other man realizes it yet.
Will knows by now how risky secrets are, and if he’s got concerns, he’s got to voice them. That’s going to be his only saving grace. He may be a horrible doctor these days, but his ethics are going to be spot on, and no one will be able to fault him for procedure.
So, he takes his boss -- his friend -- aside during a break and makes sure they are alone. Then, he confesses the truth.
“My patients are dying at an unusually high rate,” he says, putting it out there as simply as he can. “I’ve noticed it for several weeks now, and I’ve tried to trace a pattern -- something, anything -- and I don’t know what’s going on. I’ve reviewed the charts. I followed up with pathology. There are no red flags, but I know something’s wrong.”
It’s not an easy thing, telling someone that you feel like your medical skills are failing you for unexplainable reasons. The good news is that Will has little if any pride left, so he might as well put it all out there.
Will’s come prepared. He has his files printed out, and he has an aggregate of his data. Ethan takes it and skims it, but he doesn’t look surprised. “It’s been on our radar, too,” he admits. “And I’ve done what you’ve done. I’ve reviewed it. The numbers are weird -- I agree -- but I can’t find anything to fault.”
Will’s not about to take a pass, though. “A little weird? Ethan, it’s a lot weird,” he says. “This is double the rate of anyone else in the ED. And it’s been going on for a month straight.”
“But I’ve reviewed your charts,” Ethan reminds him. “You know I have to do that as part of your probation. And there’s nothing there. Most of those patients couldn’t have been saved. You’re not missing things. It’s bad luck. Massive blood loss, profound head injuries, acute strokes -- the stuff you can’t see coming. The stuff you can’t always fight.”
“Some of them, yes,” Will agrees. He gestures to the file again. “But at least once a week, someone dies who shouldn’t. Heart attacks that come out of nowhere. Unexpected heart failure. Inconclusive autopsy results. Once a week, Ethan.”
He sighs, clearly striving to be patient. “And that happens, too. Medicine is rarely black and white, no matter how much we’d like to think otherwise.”
Will allows himself a goggle. “But once a week?” he asks, incredulous. “You have a perfectly healthy patient on their way to a transfer or discharge who up and dies once a week?”
His point is made, and Ethan defers. “Are you doing anything strange?”
Will wishes it were that simple, honestly. A clear, simple answer would do him good right now, but all he has is the impossible ambiguity. “No,” he says, practically emphatic in his frustration. “I’ve been going over it in my head, trying to see if I’m lapsing on some protocol somewhere. But I clean my hands. I use fresh tools. I wipe down my iPad.”
“That wouldn’t even be the source,” Ethan points out. “I mean, your patients -- they’re not generally dying of infection.”
Will considers this, shrugging one shoulder. “I guess not. But that’s the problem. There’s no common thread.”
“That’s not a problem. That just reinforces what I said all along: this is probably random,” Ethan tells him.
Will can’t help but visibly deflate, and Ethan quickly follows up.
“But we’ll keep an eye on it,” he says, almost as an afterthought. “Both of us.”
“Would you?” Will asks, hopeful and relieved.
“Sure,” Ethan says. “I mean, I don’t have any doubts about your work, but it can hurt to doublecheck things.”
“Thanks,” Will says. “I don’t know what’s going on -- I can’t place it for the life of me. But something’s off. Something’s just not right.”
Ethan smiles, a little bemused. “You’re overthinking things, Will.”
Will has to chuckle. “Bet you never thought you’d say that.”
Ethan grins. “First for everything.”
-o-
So Will doublechecks.
Then, when that fails. He triple checks. He tracks everything -- every little detail, no matter how random. He creates his own supplemental charting system, documenting the nuances of his patient interactions.
This is when Will starts to notice the little things seemingly outside of his control. See, after his traumas are done, the rooms have to be cleaned and documented. There are a number of misplaced drugs in relation to his traumas with vials being found after the fact in the wrong place. There are also charting inconsistencies, he discovers, as he cross-references his patients. His notes are overlaid with those from the nurse, and the discrepancies are suddenly more telling than he’s remembered.
The amount of each dose is sometimes off. The timing of the dosages has been changed.
It’s almost always Emily.
Such small things are often overlooked in the chaotic ebb and flow of the ED, but as Will looks at the trend holistically, it’s startling. Emily’s not just missing a few steps. She seems to be operating on a whole different level.
Now, on some level, Will’s known this all along. But this isn’t her lackadaisical approach to procedures. It has nothing to do with her slow response time or her overly personable approach to patients. Her lack of precision in charting could just be sloppiness in her paperwork, but that’s the problem. Without accuracy there, there’s just no way to know.
He starts to watch her more closely. He corrects her more regularly. When he questions her choices, she laughs at him. “I have the right amounts in my head, don’t worry!” she says about the undocumented doses.
“There’s plenty of evidence to suggest that hospitals are too aggressive with their medication regimen. We have to let patients rest, you know?” she tells him when he asks about the timing of doses.
“I’m not a secretary, I’m a nurse!” she insists when he points out her inconsistencies on the charts.
There’s always an excuse.
Never an answer.
-o-
No answers, but more questions. If Will weren’t drowning in paperwork, he might have time to ask them all. As it is, he can barely keep his head afloat. With the number of inconsistencies he’s finding, his charting takes almost twice as long. In short, there’s just no time for it all, and Will’s been keeping his head above water for the last six months, but it’s pretty clear that his treading just isn’t good enough anymore.
To clarify: he’s not good enough anymore.
What’s worse, no one seems to notice. Maggie tells him how great he’s doing. Ethan is always thanking him. By all accounts, he’s doing great.
It figures, then, that the only person who sees him struggling is the one person at the heart of it: Emily.
She’s sweet, and she’s well-intentioned. She’s part of they team, whether anyone likes her or not, and Will’s still working to get her up to snuff. He’s the kind of guy who needs a thousand chances. He feels compelled to extend them to her in return since he knows how much she cares.
He likes to think that matters.
Will, of all people, has to think that matters.
And besides, even though he knows she’s part of his problem, he can’t exactly go blaming a nurse. He’s the doctor; the buck stops with him.
Besides, despite all of Emily’s shortcomings, she is really good at comfort.
Like really good.
It’s no wonder patients are drawn to her.
When she makes it all about you, it’s like you’re the center of the world. During hardships, that sort of attention can be everything.
He tries to deflect her -- to keep things professional -- but she’s pretty convincing.
And Will is pretty lonely.
“You can tell me,” she says, leaning on the counter across from him at the admit desk. “I can see that something is wrong.”
He has to scoff because his only other option is to cry. “What’s not wrong?” he admits. He lowers his voice and looks around. “The whole things a mess. My paperwork is a mess, and Ethan is looking at everything I do, and I’ve been so focused on the quality of my work that my quantity is way down. I’m not seeing as many patients, and my other numbers aren’t improving.”
In other words, it’s all going to pot.
“Well, that certainly sounds dire,” she muses toward him, still nonchalant.
He gives her a plaintive look. “Emily, I’m serious.”
“And so am I,” she says, growing a little more serious. “Worrying doesn’t make anything better. You have to focus on the relevant factors.”
“I am,” Will says. “The relevant factors are that my ability to take care of patients has diminished.”
“Your ability to chug them out like an assembly line, sure,” she says. “But that’s not why you’re a doctor. I’ve seen the quality of your care, and you’re the best. The numbers aren’t important.”
That’s a tempting out, a nice platitude, but it doesn’t hold much weight. “They are, though. They’re really important. It’s my ass on the line.”
At that, she frowns. “You really think they’ll fire you?” she asks. “Because of your probation?”
He sighs, pursing his lips a little uncomfortably. He looks down again, blindly studying his iPad. “Maybe,” he says. “But it’s more than that. It’s everything. My career. My whole life.”
She tilts her head to the side. “Your career is your whole life?” she asks, sounding skeptical.
He takes the note with a small dose of chagrin. “Well, not my whole life,” he clarifies. “But it’s a big part of it.”
She lifts her brows. “What about your hobbies?”
“Who has time for hobbies when I work 12 hour days?” he reminds her.
“Family,” she ventures next.
He sighs. “I have a brother, but he’s a cop. He’s busy, too.”
“Significant other?” she asks.
Will looks away once more, doing his best not to redden. “Not right now.”
She looks sorry for it, and she reaches out her hand to his. “I’m sorry. But I’m sure you’ll find someone.”
He pulls back, flustered now. “No -- I’m not--” he starts and has to stop while he shakes his head to get his head screwed back on right. “Look, this isn’t really appropriate. And besides, I don’t have time for it. I need to get back to work, and so do you.”
“Sure, sure,” she says, and somehow she sounds condescending. Her lips tip up into that little smile of hers. “You do that.”
“You do it, too,” he reminds her. “We’ve got a patient in three and another in five.”
She nods along. “I’ve got your back, Dr. Halstead,” she says. “You can count on me for that.”
It’s meant to be a comfort.
Moving away to his next patient, he’s not sure why it doesn’t feel like one.
-o-
There’s no time to think about it, anyway. He can’t think about Emily.
Not when his patients are still in such a precarious position.
Not when he is in such a precarious position. He needs solutions, not more problems. He needs to find a pattern, a lapse, a weakness: anything.
He doesn’t have time to look at half competent nurses anymore.
Will knows his priorities after all this time.
-o-
Now, Sharon is not a naive sort of woman. She understands her job, and she understands its complexities. You don’t go into medicine expecting clear cut answers and simple solutions. And you sure as hell don’t go into management if you want things to be easy.
So, she expects complication. She’s fully prepared for all sorts of obstacles and trials. She’s trained for all of it, and she knows how to face it with poise, grace and determination.
Pandemics? Sure. She’ll come up with innovative protocols to keep them operational even during the worst of times.
Staffing shortages? Okay. She’ll handle the time management and approve transfers to make sure that everything stays staffed and functional, and the hospital doors stay open.
Doctors stealing trial meds? She has to admit, that was a new one, but she dealt with it as well as could be expected. She’s even gotten Kender to start returning her phone calls, so there’s hope that maybe it won’t have a permanent impact on Gaffney’s bottom line.
It’s just, this death rate thing.
It’s not that it’s never happened before. They’ve had spikes before. They’ve had negative trends. Once, a few years back, Sharon had managed to unearth a source of contaminated surgical gear that led to a series of infections. She’s tracked MRSA outbreaks. She’s fired nurses for lapses in cleaning.
Death rates change.
Sharon has always changed to combat it.
She’s always, always fixed the problem.
But this one, admittedly, has her flummoxed.
She goes out of her way to do additional data collection. She runs tests on their suppliers, looking for any notable changes. She checks the admission procedures in the ED, and evaluates them for any recent lapses or alterations.
There’s nothing, though.
There’s absolutely nothing.
In truth, that’s good news. It means all the policies and procedures are in place and working. It doesn’t, however, explain why patients are dying.
Why Dr. Halstead’s patients in particular are dying.
At a certain point, she feels like she’s fighting the inevitable. There’s something to be said for Occam’s Razor, she fears, and she doesn’t want to stand in the face of the obvious and keep looking for something else.
The problem is the obvious isn’t obvious at all.
What does it even mean? It’s not like Dr. Halstead is murdering his patients. That’s absolutely asinine to even think about. Dr. Halstead has many flaws, but he’s a good doctor who cares about his patients. In fact, his desire to keep patients alive is often what gets him into trouble. He’ll cut corners -- but only to improve patient outcomes.
Therefore, any lapse from him would not seem to be linked to negative outcomes. That’s just not who he is.
But each piece of evidence she gathers is just as telling as the last.
Normally, she’d launch a formal review and just be done with it. But the hospital’s in a precarious position. Money is tight; publicity isn’t great. They can’t afford too many more hits in the newspapers, and something like this death rate problem would certainly make waves. It could spook shaky donors, and they’re only a few donations away from having to close a department.
Plus, an investigation alone will probably end Dr. Halstead’s career. On probation for serious missteps already, the board won’t care for nuance. Dr. Halstead has essentially struck out already. The only reason he’s had any reprieve is because Sharon has vouched for him and the hospital is so short staffed that you might call them desperate.
Desperate seems like an apt word these days. More and more as Sharon looks at the numbers.
She’ll have to make a call at some point.
She just likes to hope it won’t be today.
-o-
Today, maybe not, but two days later, Sharon gets another call from Gwen.
They’ve gone several weeks without any actual contact, and those several weeks have been lovely as far as Sharon is concerned. Tensions have eased between them ever since the mess with the new ED nurse was sorted out, and their last interaction had been nearly pleasant. She is still waiting for final budget approval, but of all the things falling apart in Sharon’s hospital, she has found comfort in the idea that at least that relationship is in an acceptable holding pattern.
Until, of course, it isn’t.
This time, when Gwen calls, she sounds a lot less pleasant.
She sounds angry, just two shades shy of pissed off.
“I just got told about the latest ED numbers,” she says.
Sharon decides to play dumb. She has her suspicions, but she doesn’t want to overplay her hand here. “Which numbers are those?”
Most of the numbers are, after all, very good.
Naturally, that’s why Gwen is talking about the ones that aren’t. “The death rate,” she says, and at least she’s not brokering anything here. Her annoyance is genuine, Sharon has no doubt. “The death rate in the ED has doubled in the last three months?”
Sharon draws a breath, because she knows this already. It is as dramatic as Gwen makes it sound, but the last thing she needs is to make decisions based in emotion when the stakes are precisely this high. “We should put this in context,” she says. “Our death rate was very low to begin with, and when you’re talking about numbers--”
“Spare me the introduction to statistics. I did take those classes in school, thank you,” Gwen says sharply. “Explain to me what is happening and how you intend to fix it?”
As if this hasn’t been her preoccupying thought for a week straight now. “I assure you, I am currently investigating this from all angles--”
“But there’s no formal investigation,” Gwen snaps.
“Right now the data is too raw, and we need more corroborating information--”
She’s been reasonable and concise, which is exactly what Gwen likes. Except that Gwen doesn’t like what she’s saying, and Gwen is used to getting exactly what she wants. “I don’t want excuses, Sharon,” she says. “I want answers. More than that, I want results. I want an ED that isn’t killing people. I don’t really think that’s too much to ask for one of the top hospitals in the entire Midwest.”
Gwen is somewhat past the point of reason right now, so Sharon goes for conciliatory. “I want answers just as much as you do--”
“No, I’m not sure you actually do,” Gwen says. “In fact, I’m not sure you want anything you say you want. Remember that x-ray machine you’ve wanted?”
The one Gwen has been fast tracking for them since the new nurse was hired?
Gwen huffs audibly over the line. “I’m starting to think it might be better served in another department,” she says. “You know, one that isn’t killing its patients.”
It’s not that Sharon is surprised -- she’s not -- but the whole of the situation is one that she is going to have limited patience for. Because, the stakes are big here, and Gwen it playing petty. “Are you really going to try to blackmail me with ED death rates?”
She should know better than to try to guilt someone like Gwen. Gwen can’t be guilted into anything. “I’m just telling you the facts,” she replies. “Find the problem and fix it, Sharon. Or I will fix it myself, gutting your precious ED and firing every staff member including yourself. Am I making myself clear?”
Sharon holds her tongue, flattens her mouth. “Perfectly.”
Because nothing else was clear right now.
But that threat?
Was pretty easy to understand.
-o-
Will’s actually not known for his ability to persevere. He knows how to be successful, but he’s the kind of guy who starts strong and then cuts and runs when things get hard. Moving back to Chicago, making peace with Jay and his dad, finding a place at Med -- it had changed things. Will had allowed himself to believe he could persevere.
Well, it’s not the first thing he’s been wrong about, to be sure. Sometimes, it kind of feels like the last, though.
See, perseverance is supposed to be easy in concept. It’s about getting through things. It’s as simple as showing up day after day and believing that things will get better eventually.
Except, they’re not getting better.
Will’s patients just keep dying.
He’s filled out more death certificates than release forms, it seems like. That may not be true, but at this point, Will honestly can’t figure it out. It’s too many. It’s too much.
Will’s been through a lot over the last few years. He’s been coerced into an undercover operation as a CI, which nearly led to his murder and resulted in the breakup of his engagement on his wedding day. He’d been forced into witness protection for several months, and he came back racked with PTSD to the point where he alienated everyone who might have still cared about him.
After a car accident, the rest of his life had bottomed out. Trying to rebuild, he’d gotten involved with an illegal safe injection site and then fell in love with a drug addict. During a pandemic, where he had to work on the front lines, he hastily moved in with said drug addict and their relationship imploded.
Breaking up with her was necessary, and Will floundered. He got passed up on a promotion that should have been his, and he spent a year flirting with the idea of leaving emergency medicine altogether just because it felt good to be wanted. However, he’d botched that opportunity just like he’d botched his career at Med. He’d also botched his relationship with Sabeena and Natalie simultaneously, and now Will was barely employed, disgraced and alone.
And this? Right now?
This is somehow worse than all of that.
He can’t get away from it, no matter what he does.
He can’t get away from her.
He knows it’s not fair to associate all this with her -- necessarily. She’s just a nurse. A little odd, well intentioned and poorly equipped for life in the ED. But it’s not like this is really her fault.
It’s just that every time he turns out -- it’s Emily.
Every time he’s doing paper -- it’s Emily.
Every time he goes into a patient room -- it’s Emily.
Every time he calls time of death -- it’s Emily.
Funny enough, the death procedures are the only ones he can count on her to do promptly.
Every time.
Every.
Time.
It’s Emily.
-o-
There’s no one he can talk to at work -- not really. Ethan wants to hear good reports, and Maggie just doesn’t know enough to do anything. Will’s trying to keep the fragile balance in check there, because he knows that the ED is barely making it work as it is.
He finds respite, his only respite, with his brother.
It’s hard to find time to meet with Jay these days. His brother’s schedule is crazy, and he’s got his relationship with Hailey to figure out. When paired with Will’s increased workload, there just isn’t much time to socialize.
Besides, Will’s pretty sure he’s bad company these days. Jay is going to regret ever telling Will to see things through in Chicago.
But they’re here. That’s as much as Will can offer these days. He’s here.
“You’re working too much,” Jay cajoles. They’re sitting at a table at the back of the bar, watching while the raucous scene unfolds in front of them. Will barely remembers what that’s like, people being happy and living their lives. Couples snuggling in a booth. Friends joking at the bar. Fans cheering at the game on the TV while a pair of buddies start up a pool game.
Jay snaps his fingers at Will, bringing his attention back around.
“Too much,” he says, repeating the words and giving them extra emphasis. “It’s not good for you.”
Will sighs, and he can’t exactly deny it. “Probably, but I don’t know what else to do. I can’t risk my job while on probation.”
It’s a well worn response that Jay’s heard before, and he seems a bit exasperated. “That’s been the card Goodwin’s played for months now. Isn’t it about time they resolved it?”
“That’s not for me to say,” Will says. “I’m the one who screwed up. I’m the one taking responsibility.”
“I know, I know, and I’m all for it -- usually,” Jay says. “But I think they’re taking advantage of you a little bit.”
Will can only shrug. “Even so, I deserve it.”
Jay gives him a look. “You covered up Natalie’s crime -- it’s not like you killed someone.”
At that, Will scoffs. It’s more raw than he’s perhaps let himself realize. “I’m not sure that’s true,” he finally admitted with a touch of ruefulness. “I’m on a bad run.”
They have different lines of work, and the idea of a bad run can mean very different things to them. Jay’s not stupid, though, and they both work in high stakes industries. It’s not just a sales quota. It’s not the bottom line. It’s lives.
“It happens,” Jay says, even as he looks mildly disconcerted. “We all have them.”
Will looks at his drink and makes a face. “Sure, we do. But this one? I’ve never had one like this before.”
Jay gives Will an expression of incredulity. “You’re probably just obsessing over it so it seems more. When you’re working under a microscope, it feels like small things are a big deal.”
“It’s not that,” Will protests. “I mean, not really. I haven’t sat down to actually run the numbers, but it feels like I’m sending more people to the morgue than home. And not just like I’m getting the patients who are most bad off. I’m losing people who were stable. People I was prepping discharge paperwork for.”
“But stuff happens,” Jay points out. “You tell me that all the time.”
It’s true; it has been one of Will’s favorite defenses in the past. It feels woefully insufficient these days. Will has to shake his head. “This just feels different.”
It’s a vague sort of determination, but Will is steadfast in it nonetheless.
Jay, though, is steadfast, too. Probably more than Will, over the long haul. “It’s just a funk, man,” he says, making a small face of indifference. “You’ll get out of it.”
It’s the perseverance mindset, the one that Will has tried so hard at and failed so spectacularly with. Still, about the only thing he’s doing right is keeping things level with his brother. When the rest of his life is on the verge of total collapse, he’s not especially keen to ruin that. “I guess,” he finally agrees with a noncommittal shrug.
If Will is trying to sound reassuring, though, he’s failing at that as well. Jay sits forward, beer pushed aside and gives Will a more plaintive once over. “Look, does anyone else have anything to say about this? Has anyone else even commented?”
That’s a point, and Will knows it. He’s still reluctant to concede it. “No,” he says. “But it’s not like we go reviewing each other’s cases. I talked to Maggie about it, though.”
Jay raises his eyebrows, ever expectant. “And?”
Will exhales, somewhat begrudgingly. “And she agrees with you. She thinks I’m reading too much into things.”
Jay’s look is overtly I-told-you-so. “And no one else?”
“Well, Emily thinks it’s no big deal, but I’m not sure she counts,” Will explains.
Jay’s brow creases. “Emily?”
“The new nurse. She just started a few months ago, but she works with me a lot,” Will explains. “So she has a first hand view of it all. My patients are all her patients for the most part.”
“And is she worried?” Jay asks.
Will sighs, feeling exasperated at this point. “No. But she’s -- I don’t know. Different.”
Jay tilts his head. “Different?” he clarifies. His eyes narrow. “Do you like her?”
Will groans. “No, just -- no,” he says. “If anything, she’s difficult to have around. She’s not nearly as intuitive in the ED as most of the other nurses.”
Jay sits back, as if Will has just said something insightful. “Well, there you go.”
Will shakes his head, confused. “There what goes?”
Jay gestures forward. “Maybe it’s her,” he says. “Maybe she’s your problem.”
It’s a ridiculous notion, and Will finds himself recoiling. “Emily? What? Like she’s jinxed or something.”
“Or something,” Jay says, and he shrugs. “I don’t know, man. But if something’s off, you look for the thing that’s different. Sounds like this Emily person lines up with your bad streak. So, that may be more than you think it is.”
“Or it may be nothing, except I’m a bad doctor,” Will shoots back.
Jay rolls his eyes. “Whatever,” he says. “I’m just saying. Start with the obvious, bro. You have to start with the obvious.”
-o-
They don’t make a late night of it -- the Halstead boys aren’t as young as the used to be, after all -- and Will isn’t really much company. He perks up a little, with plenty of cajoling from Jay, but he’s more than a little relieved when Jay calls it quits before 10.
He makes his way home, and he knows how tired he is, but he also knows that sleep isn’t going to fix his problems. He sits on the bed for a little bit, thinking about his patients that day. He thinks about Mr. Garside.
Emily is undoubtedly a commonality between all these things, but it seems presumptuous to consider her the cause. Doesn’t it?
Because Will can’t be passing the buck. He’s the one on probation. He’s the one with his ass on the line. This is his responsibility. His.
Which is, of course, why he can’t let it go.
He just can’t. He thinks about the patients, he thinks about the cases, he thinks about the number of times he’s gone to a waiting room and told someone that he’s so very sorry.
Is he messing up his medication doses?
Is he failing to take the patient history into consideration?
Is he just not doing his due diligence? Is he messing up on his diagnostics?
Or is he missing the obvious?
Will’s been on probation for months now. He’s worked at Med even longer than that. He’d been a doctor for a decade. He knows what he’s capable of, and all mistakes aside, he’s never doubted his ability to run a proper diagnostic. Even after being fired and then rehired, his performance has been good. It’s been more than good. It’s been impeccable.
What’s changed, then?
Jay’s right. There is just one thing. And it’s a nurse who doesn’t fit into the ED at all. He’s always frustrated with Emily, the way she never does what he needs and the way she has to be reminded to do basic tasks. She works contrary to him nine times out of ten.
It could be her.
Not intentionally, of course, but the lapses are real. No matter how much Will works to compensate for her, it’s her performance that he knows is lacking. And in all of that, from her skewed focused to his scattered attention, it could be compromising the care of patients.
Will knows how much it matters for him to handle this. He knows that keeping the ED running smooth is what Ethan needs from him. But this is about more than Will’s pride now. This is about saving patients, saving lives. He needs to talk to Ethan about Emily.
No one else should have to die.
-o-
It’s not a fun topic to bring up, even among ED docs who have seen the worst. Will knows he’s putting himself in a vulnerable position -- both admitting that his death rate has been unusually high and that he’s failed to help Emily adjust -- but secrets don’t work for him. Never have, never will. Honesty is about the only thing he’s got left going for him.
It’s about time to embrace it.
Better late than never.
When he broaches the subject, Ethan doesn’t look surprised. Will is not sure if he’s relieved or worried that his patient care has been the topic of some inside debate among the administration.
“It’s just between Ms. Goodwin and myself for the time being -- and maybe one of the data analysts,” Ethan says, and he is making some effort to sound consoling.
Will is not particularly consoled, however.
“Well, I’m not bringing it up just to bring it up,” Will says, trying to keep himself on track here. “But obviously, it’s been on my mind a lot.”
“Mine, too,” Ethan says. “I’ve been watching you closely, and I do review your charts. Nothing jumps out at me.”
“Me neither,” Will says. “I’ve gone over everything, and you better believe I’ve started putting extra thought into everything I do. I can’t find a single thing that's different -- except one.”
Will is hesitating, and Ethan looks eager. “Oh?”
Will sighs, and knows he has to just say it. “The shift coincides almost perfectly with when I started working with Emily.”
That’s not the answer Ethan’s expecting. And, why should it be? Will is going out of his way to bring attention to the performance of another staff member, a staff member who has, effectively, been under his supervision. That makes him uniquely qualified to see her mistakes, sure. But it also puts him in an unusual position of responsibility. He might as well be confessing to his own incompetence.
Ethan does appear somewhat distressed by this. “You think it’s Emily?”
“I don’t think it’s necessarily Emily, but she’s not exactly fully adapted to the ED,” he says. “I’ve been trying for months now, hoping to get her up to speed, but she just doesn’t work the same way as the other nurses. That’s why no one can seem to get her off my cases. She just doesn’t fit anywhere else.”
“I thought that was a good thing,” Ethan says, still concerned. “By pairing you two up, it’s helped streamline ED production.”
“But look at my cases with her compared to my cases with other nurses,” he says. “It’s dramatically different.”
“The comparison size is too small--”
Will nods, eager to make this point. “And isn’t that part of the problem? The nurses are rotated, and with good reason. I think it’s possible we’ve created our own problem here. She’s getting to set in patterns -- I’m getting too set in patterns -- and it’s causing lapses. I don’t know how, I don’t know where yet -- but something about her is the source of this.”
At that, Ethan’s expression shifts from concerned to grave.
“We all have our own methods, and I admit, some of hers could be different,” Ethan says. “But her results are clear; patients love her. She gets the highest marks on patient exit surveys -- way better than Doris, even better than Maggie.”
“Patients love her, but none of the nurses do,” Will says. “And as one of the primary doctors who has worked with her, I can’t say she’s exactly on par with the other nurses. This isn’t all about who can hold a patient’s hand. It’s about the quality of care we’re providing.”
Ethan makes a face, as though this is somewhat exasperating for him. “She’s still new. And it’s no surprise that her priority for patient care somewhat impedes her connection with compliance issues. Besides, that’s really been your charge, isn’t it? To get her integrated?”
Will is feeling increasingly incredulous. “But Ethan, this is your ED. Compliance, policies, procedures -- I’ve taken all that to heart, and I’m telling you. There’s something off about Emily. She’s not picking it up. Any of it.”
“But I’ve learned the hard way that sometimes you have to lighten up, have some give,” Ethan reasons. “And you know how paperwork is. Inconsistencies happen. It’s not a crime or some kind of conspiracy. Sometimes it’s stylistic. Sometimes you just have to learn the ropes.”
This sounds reasonable, and maybe it is reasonable on the surface. But Will knows his patients. He knows his own practice of medicine.
And he knows that something is wrong.
He’s examined his own choices first, but this time, he’s come up blank. This time, all he’s got is this.
“Ethan, please,” Will says. “I’ve gone over every case. I’ve evaluated every procedure. Emily is the only thing I can find that’s different for me lately -- and she’s the only consistent factor with every case I pulled.”
Ethan sighs. “Will--”
“I’m not saying it’s nefarious. I’m not even saying it’s bad or intentional or whatever,” Will says. “But if she’s not got our procedures down, then she could be failing in more ways we haven’t realized yet. And I know better than anyone how letting a few things slide can make the whole thing collapse. We have to look into it. For the sake of our ED patients.”
To this suggestion, Ethan’s expression is grim. “Will, I know you’re stressed out--”
He shakes his head. “That’s not what this is--”
“And I know you want to prove yourself--”
“Ethan, I swear to you, that’s not what this is,” Will says again, even more insistent. “I know it seems like I’m trying to pass the buck, but the opposite is true. I just want the truth -- for my patients and this ED.”
With a long, slow breath, Ethan remains unconvinced. “You say that, but you’re standing here with a stack of dead patients, telling me how you want to blame your nurse. Not just any nurse. A new nurse without any credibility built up. It looks like you’ve picked the easiest target, but you’re forgetting that you’re the one on probation, Will. I’ve been on your side throughout this process, but we can’t be naive, and you can’t afford to go around making accusations you can’t back up.”
“I know that,” Will says, because he does. He does know that. He just doesn’t know what else to do at this point. “But Ethan, my patients keep dying. One or two -- yeah, that happens. But I’ve lost track now. Patients I thought would live -- keep ending up dead. There has to be a reason.”
“Okay,” Ethan says, and he’s clearly trying to be patient. “But you’re emotionally attached to this. That doesn’t make you unbiased here.”
That answer is moderately infuriating. “I know,” he says. “But it also means I’m motivated to figure this out, and it seems like I’m the only one. I’ve been over all these case files. I’ve gone over my own procedures in my head. And I can’t find anything except Emily.”
He’s getting worked up, and he knows it. There’s a part of him that recognizes that his emotion is making him less credible, but he can’t stop himself.
He just can’t.
He’s supposed to be picking and choosing his battles, but if saving his patients isn’t the stand he’s supposed to take, then he’s not sure what is.
“Okay, okay,” Ethan says, clearly placating him now. “I know you’re upset, but you need to calm down.”
Ethan’s trying to be reasonable, but Will’s about five dead patients past reasonable. He shakes his head. “I can’t.”
“But you have to,” Ethan says, and he leans forward. “Will, I’m on your side, but not everyone is. You have to be careful.”
Will frowns. “That’s exactly what I’m being,” he argues. “That’s why I’ve scoured my case files for anything.”
“And you come up with blame the nurse?” Ethan asks.
“Ethan--”
“Will, just -- listen,” Ethan says. “Keep your eye on her, okay? Double check her work -- and yours. If you can come up with more concrete evidence, I’ll take it to Goodwin and run with it. But until then, you’ve got to keep your head down.”
Will leans back from him, feeling stiff. “And if my patients keep dying anyway?”
Ethan shrugs grimly. “You better hope they don’t.”
Will knows he doesn’t deserve solace, given the position he’s in.
But that’s the coldest comfort yet.
-o-
Sharon gets a lot of messages. She listens to them all, and she gives them all her equal attention. That’s just part of the job.
That doesn’t mean she likes them all the same.
Or that she responds to them all with the same vigor.
Such is the case when Gwen leaves her a voicemail.
Which, of course Gwen does. Gwen is not a hands-on administrator in some ways. She’s not hanging out in the ED or doing ride alongs in the OR, as it were. But Gwen likes an immediacy in her interactions, she’s a smart enough woman to know that a line of text isn’t going to carry the same weight as an actual voice.
Gwen wants Sharon to hear her, in a very literal fashion. That makes context easier to understand. When she’s happy, it’s easy to tell. When she’s worried, that’s easy, too. And, of course, when she’s pissed off, that translates very easily into her tone. She suspects Gwen likes to think the sound of her voice will be a motivating factor of some sorts.
As if that’s going to scare her.
It doesn’t scare her.
But it gives her context for just what kind of day this is going to be.
Most of the message is benign as Gwen runs down the list of things to talk about at their next meeting. She wants refreshed and in-depth departmental reviews, see. She disapproves of the progress being made in cardio -- after losing Dr. Downey and Dr. Rhodes, they’ve never quite recovered -- and Gwen is about ready to recommend firing everyone who works in radiology if their performance records don’t seriously improve. Sharon doesn’t necessarily disagree with that; there’s been some issues, especially with surprise billing, down in that department. She’s a bit weary of going over it again and again, and in truth, she might side with Gwen this time if push comes to shove.
Oh, Gwen adds at the end of the call, she also wants to talk about the ED. She’s seen the numbers lately. And they seem weird. Do they seem weird to Sharon, too?
She’s not angry about that.
Sharon suspects she will be when she realizes just how much Sharon has noticed these days.
-o-
And for once, her interaction with Gwen is not the downfall of her day. Instead, the curious part happens later, during a meeting with Peter, the hospital’s main lawyer. They go over the basics, and he hems and haws before Sharon asks him what he really wants to talk about.
“It’s a little delicate, I’m afraid, and I’m just not sure who to talk to,” Peter admits, looking moderately disconcerted. “It concerns the board, but that’s really the problem. I’m not sure I’d get unbiased feedback.”
Peter’s hesitation is telling, but he’s scant on details. “Okay,” she says. “What’s it about?”
“A donor,” he supplies, a little relieved at the opportunity to go into some detail. “I’m starting to have a few concerns.”
“Okay,” Sharon says, because donor relations do fall within her purview. “Which one are we talking about?”
“Well, I can’t really say,” Peter says. “Not without making this legally more complicated.”
Sharon smirks a little, but the deflection is no surprise from Peter. “Well, then you know I can’t help you all that much.”
He seems to be uncertain about what to say next. “It’s just -- the money, see?” Peter posits. “It’s flagged for the ED.”
Sharon shrugs, somewhat indifferent to that particular revelation. “And how is that a problem? Money is flagged for certain departments and purposes all the time.”
“Of course,” Peter agrees. “But I always go over every donation, just to make sure the legal groundwork is solid, you know? I want to make sure we’re not leaving anything undone or unchecked. With donations of this size, the IRS really tends to want to make sure that nothing’s been missed.”
“Sure,” Sharon says, for that much is clearly evident. “And is there a problem with the paperwork?”
He makes a face, hedging even worse than before. “Not exactly,” he says. “It just seems -- I don’t know how to put it. It seems less than developed. Like, all the boxes are checked, but none of the details are filled out.”
Sharon lets a frown deepen on her face. “Can’t you go back and ask for more details?”
“With donors like this? You don’t want to be burdensome,” Peter says. “And I’m not sure if I’m overreacting. I think technically it’s all above board, but if there’s any kind of review or audit, I’m almost positive this donation will be flagged.”
That sounds somewhat ominous, but Sharon finds herself even more bothered by Peter’s reticence here. Peter’s good with the legal framing of things, but he’s not usually so keen to keep his cards this close to his chest. He is worried here. “Peter, I want to help you, but you will have to be more specific. Who are we talking about? If you don’t tell me, then my feedback isn’t going to mean much.”
“I know, I know,” Peter says quickly, almost sounding guilty. He shakes his head. “It’s just weird.”
“Then, maybe you should talk to the board,” Sharon offers as another way out.
But Peter quickly shakes his head again, this time more vigorously. “I can’t,” he says. “The board already approved it, no questions asked.”
This doesn’t make much sense. “What do you mean?”
Peter clarifies. “All clearance came from the board already. Their highest approval,” he says. “The file they gave me to clear? Was redacted by Gwen herself.”
Finally, the implications are clearer. Peter’s worried, but officially he has no grounds for it. He’s between a legal rock and a hierarchical hard place. “Oh,” she says now. “So this is the big stuff we’re talking about.”
Peter nods readily, somewhat relieved for her to understand his predicament. “It is.”
“And you’re afraid to question it,” Sharon presumes.
“I’m afraid of giving her the wrong idea with questions,” Peter says. “Questions she may very well have the answers to, but I don’t know because so many details have been omitted.”
She can appreciate his precarious position, if only because it’s one she’s been in before. They walk a delicate line; they do a careful dance. The margin between success and failure is slim at the level they work at, and they are both keenly aware of their own position. “Well, Peter, I’ve got my own problems,” Sharon commiserates.
He frowns, focus suddenly shifting. “Anything legal?”
Sharon has to chuckle, but it’s a dark sound. “I hope not. Just some performance issues, I think.”
He still looks disconcerted. “That sounds potentially legal.”
Sharon shrugs, but she doesn’t outright disagree. “Probably an HR issue first,” she says. “But I’m going to see if I can nip it in the bud myself.”
“Let’s hope,” he says, gathering his things. “Because I’ve got enough on my plate.”
“If you need more help with the donor issue--”
Peter smiles at her, but the look is dismissive. “We’ll all just do what we can, right?” he says. “And hope like hell it doesn’t blow up in our face.”
Sharon smiles sympathetically. “That’s not the most optimistic take.”
Peter shrugs, somewhat helplessly. “Tell me I’ve got a reason for optimism.”
Sharon sighs and nods to the door. “When I find some, I’ll let you know.”
“Good luck, Sharon,” Peter says with just a touch of grimness on his way out. “Somehow I feel like we’ll all be needing it.”