Chicago Med fic: Resolution (4/7)
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
-o-
Natalie’s message had been short, but its impact loomed large. He couldn’t get it out of his head the whole night, and it distracted him all throughout the next day. Unable to cope, he pulled back a little. No matter what he did, he couldn’t deny that he just felt sad.
One day became two. Two became a week.
Will couldn’t figure it out. He couldn’t make sense of his own head anymore.
He was doing good work. He was doing something meaningful with his life. He was even making real connections with real people right here.
But something was missing, something he couldn’t quite place and couldn’t quite define.
Something he couldn’t quite shake.
No matter how much good he did, no matter how much of himself he poured out, he couldn’t shake it for a second.
-o-
Then, just to make things fun, Will got a terrible case at work.
Working in an ED, you saw horrible stuff. You dealt with death and pain on a daily basis. He had a front row seat for suffering and tragedy, and he’d been in the game long enough to understand its inevitability. That was why he had to do what he did. He had to stand on the front lines because most people couldn’t fathom it.
There were days, however, when he couldn’t fathom it either.
Yet, he was still expected to face it all the same.
Her name was Abena Gbeho. She was 28 years old, and had a successful career as a teacher in the city. She was married with two young children under the age of five. The family was involved in a car accident, during which Abena incurred most of the injuries. With a broken back and a badly contused heart, Abena needed immediate surgery. That was when she stopped him and took his head.
“No,” she said, locking eyes with him and speaking clearly. Despite her injuries, she had been conscious and coherent for most of her time in Will’s exam room. “No surgery.”
“Abena, I understand that you’re worried, but surgery is necessary,” he said. “Without it, you will never walk again, and your heart will arrest. You will die.”
She nodded, but there was no fear in her expression, not like you might expect from a woman facing paralysis and death. “I will die,” she said. “Now, tomorrow, in a month. I have a tumor. In my brain. It is killing me slowly day after day. I do not want this. No surgery.”
Will was scrambling to keep up now. “Wait, a tumor,” he said. “But your history--”
“It is cancer. We are treating it, but there is no indication that it is going away,” she explained.
“We can do the surgery without interfering with your treatments--”
“I do not want this,” Abena told him, clearly and slowly. “Please.”
“But what is the condition of your tumor? Who is your doctor? We should look at your files--”
“I am done,” Abena said. “No more extreme measures.”
“Abena, I understand your position for end of life care, but your injuries today are fixable,” he reasoned.
“And for what?” she asked. Her hand was gripping his arm now, almost unrelenting in his strength. “To suffer another day?”
“But if your cancer can be treated--”
Her fingernails were practically puncturing his skin now. “I do not want it!” she insisted. “Get my files. Check them. I have a DNR.”
And Will’s whole body went cold. His mind stopped working.
Because his patient, with every chance of recovery, was refusing treatment and had signed a DNR.
Because of course she had.
-o-
A DNR was a big deal in the medical world. When a patient had a DNR, it was indicated on every piece of paperwork. Signs were posted on the door. Every staff member responsible for treatment was briefed.
So if Abena had a DNR, then Will wanted to do this right. This was the exact kind of case that warranted his new by the book mentality around medicine -- and life.
The files provided unequivocal proof of the DNR status, but it was a more complicated history than Will had fully anticipated. Abena would die from her tumor, even if later than probably sooner. Given the progression of the tumor, the death would not be pleasant and the decline would be precipitous. Such situations were the reason DNRs were invented in the first place.
Yet, the file spelled doom, but not immediate doom. Abena’s treatments had successfully slowed the tumor growth. She might have years.
A few years in comparison to a lifetime was still a raw deal, but Abena had young children. If she lived today, she would get to see a few more milestones. She might get to take them to their first days of school. She would build precious memories that they would cherish for the rest of their lives.
To Will, the choice seemed obvious, but there was the rub. It wasn’t up to Will. It was Abena’s life, and it was Abena’s choice. Her delineation of her condition had been apt enough. She seemed to understand the parameters here. If she didn’t want to be treated, then Will had to respect that.
He had resigned himself to that when Abena’s husband sought him out.
Anxious and still bloody from his own stitches, he wrung his hands as he approached. “I’m sorry to bother you, Dr. Halstead,” he said. “My name is Eliud. I am--”
“Abena’s husband,” Will supplied for him. He smiled and offered his hand. “It’s good to meet you.”
Eliud managed a smile, but only just. “I was told my wife had very severe injuries,” he said, glancing anxiously about himself toward the treatment rooms. His wife was in one; his daughters were being stitched for superficial wounds in another. “And I am curious why she has not been taken to surgery.”
Will nodded, even as he had to wince. “I understand your confusion,” he said. “At this point, we’ve done basic triage and identified the worst of her injuries, but Abena doesn’t want the surgery.”
Eliud stared at him for a long, bewildering moment. “She does not want it? But she said her heart is bleeding! She has said her back is broken! These must be fixed, yes?”
“The heart injury will be fatal without surgery, yes,” Will said. He knew from the file that the husband had next of kin privileges. Abena had consented all medical information to be shared between them. “The back injury is harder to pinpoint. Without getting in to look at it, it’s hard to say if she’ll be paralyzed or not.”
Will was trying to keep things as simple as he could -- this man had been through enough already, too much -- but Eliud did not seem to understand. “No, this does not make sense. You must fix what you can fix. The DNR is for the unfixable. Not this.”
“Not according to Abena,” Will said, wishing his answer could be differently. Left up to him, Abena would have been in the operating theater an hour ago, but that wasn’t his call. No matter how much he wanted it to be. “I went over the risks and gains. She was adamant she didn’t want it.”
Eliud shook his head, and he was adamant in his own right. “No, she is not thinking clearly. Perhaps she hit her head, yes? She is not herself.”
That was the kind of out Will would have looked for at most points in his career. He would have been over the case with psych already, searching for a way to override the obvious. He couldn’t, though. His instincts were swelling inside him, and he forcibly ignored them.
It didn’t feel right.
But he knew better.
He held onto that -- with all that he had left.
“I understand that this is very difficult for you, I do,” Will said, and he was emphatic in his sympathy. It wasn’t forced; it wasn’t an act or an affectation. “But I spent a lot of time talking with your wife. She was completely confident that she wanted the DNR applied here -- and that she did not consent to any further surgical intervention for the injuries she sustained today.”
By this point in the conversation, Eliud looked mortified, and he shook his head ever more adamantly. “No, the DNR was for the cancer treatment, not this,” he said, as if he couldn’t possibly understand otherwise. “I want you to save her. We have planned a future together, short though it may be. I am her husband, yes? I have a say.”
“Unfortunately, that’s not really how it works,” Will said. “Abena has put time and thought into her decisions here, and she has every right to decide her own medical care.”
The look of horror deepened on his face. “But she does not have to die!” he said, voice starting to rise. Will looked around, feeling conspicuous and anxious as the familiar pang of doubt started to gurgle in his gut. The husband advanced on him now, away from the room where his daughters were still being stitched up. “The other doctor has explained it to me. There is a sixty percent chance she will live. A fifty percent chance she will walk again.”
As if the odds changed anything. Will hadn’t allowed himself to concretely quantify the odds. The second he’d learned that Abena had a DNR and was refusing treatment, he hadn’t been able to think about it. The odds only confirmed how much this was going to hurt.
“The odds really don’t matter,” Will said. “Abena has not given her consent, and that is her choice.”
“But what is your professional opinion?” Eluid demanded. “You would get the surgery, yes?”
“But it’s not my opinion that matters,” Will argued. “All I can do is give Abena the facts, and she gets to make the call.”
His face contorted, fingers curling into fists. “No!” he said, letting his voice rise. They were drawing anxious looks from other people in the area. “She is not thinking clearly! You must do the surgery!”
The prospect of a dramatic scene was the last thing Will wanted -- the last thing he needed. As Chief of the ED, he was supposed to be in control of things, and right now, he could feel how elusive such control actually was.
“Look, let me review your wife’s case a little longer. We have some time before her condition becomes irreversible,” Will reasoned. “I’ll reassess her prognosis, and go over the options with Abena one more time. Until then, you should spend time with her as well. Tell her how you feel, and listen to what she’s feeling. The best case scenario is the one you two can agree on together.”
It was a sensible course of action, something of a compromise -- even if it did only delay the inevitable. Eluid needed closure, and Will couldn’t give it to him, but Abena could.
Or Eliud could give Abena hope.
Either way, all Will could do was be a doctor.
And he had to let his patients be people.
-o-
He took Eliud back to Abena, and he told them both he’d be back shortly. He had other patients on his service that day, but Abena’s time was pressing. Saying he had an hour was a way to placate her husband.
For Will as a doctor, the timeline was a bit more strenuous.
He had to research her condition, run repeat scans and talk to her oncologist within a very short period of time in order to provide a final case to Abena. He started by sending her back for brain scan, hoping that it might provide more details on her current condition. While the scans were processing, he poured over her files again, tracking her progress from treatment to treatment. He put in a call to the oncologist, who fortunately responded to his inquiry quickly, and she provided a more personalized view of what Will already knew and what the repeat scans were rapidly confirming.
The tumor had been large to start -- and it had been diagnosed when Abena came in with sudden onset blindness. A good portion had been resected in surgery, restoring her sight, but the tumor still remained. With aggressive treatments, including chemotherapy, radiation and a targeted drug cocktail, the tumor’s progress had been slowed, but it was only a matter of time before her functions were affected again.
Everything was on the table.
Sight, language, movement, cognition, memory.
She would never beat the tumor. Abena’s death would be slow, painful and inevitable.
That said, the scans indicated what the oncologist enthusiastically confirmed. That death might not be for years. Her initial prognosis had been bad, but they’d made a lot of headway. With the current plan, Abena could live long enough to see her girls grow up in a real way. There were still good years on the table.
Assuming her current condition could be fixed. The heart injury was straightforward enough, but Will had to admit the back injury was far less conclusive. What if Abena was paralyzed? What if she was unable to walk and condemned to a slow decline? Was that fair? Was it humane?
Reasonable people could disagree, and it didn’t even have to be reasonable. Patient autonomy mattered, and Will had been far too loose with medical ethics for far too long.
It wasn’t his call to make.
So, armed with his talking points, he went back to discuss the matter with Abena one more time.
“Abena,” he said, pulling a chair up to her bedside. They had put her on the slightest of inclines, but due to her injuries, she had to be immobilized and flat on her back. It didn’t help his case, probably, but he was going to try anyway. “How are you doing?”
Abena smiled, and it looked more genuine than it seemed like it should. “Better than you think,” she said. “I asked my husband to step out. He is taking this hard.”
“Which is understandable. It’s a lot,” Will said. He drew a breath, leaving his break thoughtful.
Abena was dying, perhaps, but she wasn’t stupid. “You are going to try to talk me out of it.”
“I just want to go over it with you again,” he said. “I promised your husband I would. As a doctor, I feel compelled.”
Abena sighed somewhat, but she gave a small nod of her head, as much as she was able to while immobilized. “Very well, then. Make your case, Dr. Halstead.”
“I looked at the scans. I reviewed your file. I talked to your oncologist,” he said. “On your current course of treatment, you still have several good years left, maybe more.”
“Years I was looking forward to, yes,” Abena said. “Do not think me callous. I want to be with my husband. I want my girls to remember who I am.”
“And surgery can give you that,” Will said.
“Maybe,” Abena said. “And at a price. You can tell me that I am likely to live, but I know how to read between the lines. There is a good chance I will not walk again.”
“The paralysis is for your lower extremities only,” Will said. “Even if we can’t recover feeling of your legs, we might be able to retain feeling in your pelvic region, which would allow you to maintain some quality of life.”
“But if you cannot,” Abena said. “Dr. Halstead, it is not just each breath we take. It is the way we spend those breaths. If I cannot think and feel and speak, then that is not leaving. And if I cannot walk -- if I am alive only to be carried around until I die -- then, that is not living. I know it is not the choice everyone would make -- not you, not my husband -- but this is the last choice I get to make.”
“Then I have to clarify, one more time,” Will said. “If you refuse this surgery, you will die.”
“Yes,” she said, eyes locked on Will’s.
“And if you do not reverse the DNR, you will not be revived,” Will said, and he knew he was pointing out the obvious, but this was just as much for him as it was for her.
This time, she smiled once more. “Yes, Dr. Halstead. I am myself today. I do not wish to be some fraction of myself. No matter what anyone else thinks or says or believes, I know who I am. And the fear of losing that is more than the fear of losing all the rest.”
That was it, then.
He’d made his case.
He’d laid out the terms.
Now, he had to accept her choice.
Accept her death.
“Okay, Abena,” he said. “No surgery. No resuscitation. Tell me what I can do to make you more comfortable.”
Her smile warmed gratefully toward him. “Just bring me my family,” she said. “One more time.”
-o-
As a doctor, Will was trained to save patients. He’d studied medicine, he’d hone his craft saving lives.
He’d accepted a long time ago that he couldn’t save everyone.
Now, yet again, he was trying to come to terms with the reality that not everyone wanted to be saved.
To be clear, he hated it. It went against all his instincts. If physically pained him to set aside treatments he knew would work and opt to do nothing instead.
Medical ethics didn’t ask what you could do.
It asked what you should do.
When Will’s instincts said one thing, he had to remember that hospital policy said another. Protocol dictated what his instincts struggled to accept.
So Will never booked the operating theater. He never prepped Abena for surgery.
Instead, he gathered her husband and children, bringing them to her room. He increased her painkillers, enough to take the edge off without making her drowsy. He settled down in a corner of the room to monitor her vitals. If this was her choice, then it was his choice, too, and he would see it through -- see her through -- until the very bitter end.
Will was taking it hard, that much was certain.
Eliud was taking it harder.
When Will got him, the man had been nearly silent with his rage. He’d been pale and stiff, barely talking as Will led him back to his wife. Strung so tense, Eliud had been trembling, almost ready to burst.
But then, on the inside, he saw his wife.
And the rage deflated.
In its place was a grief so raw that Will almost couldn’t take it. He came to her, crossing the distance between. Although Abena was immobilized, Eliud took her face in his hands and drew himself closer. He pressed their foreheads together, eyes squeezed close as he breathed her in.
He whispered, in a dialect Will didn’t catch, and then kissed her on the lips.
She returned his kiss, and then whispered an invective of her own, and Will didn’t need to understand the language to know what they were saying.
They were saying goodbye.
After a life shared.
After a love endured.
They were saying goodbye.
The two little girls came close next, and they gathered together -- a family, just how they were meant to be.
Just how they would never be again.
A husband without a wife.
Daughters without their mother.
Will had resigned himself to this, but his heart rebelled -- almost violently. He couldn’t sit idle. He couldn’t.
“If you need anything, the nurse is right outside,” Will said. “And I promise, I’ll be back in a few minutes.”
Abena barely acknowledged him, and Eliud didn’t bother at all. Will slipped out, the feeling of his own fluttering heart loud in his chest. He knew he needed to leave a briefing with the nurse, but he didn’t trust himself to speak. Instead, he cut his way through the ED and up to the stairs. He took them, two at a time, until he reached the administrative floor.
Getting out of the stairwell, he took a hard right turn down a familiar course. Usually, he didn’t choose this path. Usually, it chose him. But this wasn’t about that moment in Ms. Goodwin’s office when she had fired him. This was about something else, and if Will was stuck between policy and his instincts, then he needed someone to change the policy.
Before his instincts broke him.
Fortunately, Dr. Dunst was available, and he had earned enough credibility to request an impromptu meeting. He was allowed inside, and he found her working at her desk.
“Dr. Halstead, you have just caught me,” she said. “I am due over in neurology shortly. They want to impress me with a request for a new imaging machine, but I am not convinced. So whatever you need, I suggest you make it short.”
In his mind, he had come with a reasonable request with logical backing. He intended to be calm, collected and rational.
Standing there, though, the conflict between medical ethics and his instincts as a doctor were too much. Shaking his head, he all but blurted, “My patient has a DNR.”
It wasn’t so much what he said, but the way he was saying it. Dr. Dunst slowed to a near stop, and she looked him over carefully. “Yes, I have heard this,” she said. “I had a pair of nurses in here earlier, expressing how upset they were.”
“Because it’s not fair,” Will said, and all thoughts of rational had eclipsed him now. The strength of these emotions always surprised him, how he could share a grief that he had no part in. “We can treat her, give her good odds for recovery.”
“This case is unique, though,” Dr. Dunst said. “I was told she has terminal cancer.”
“Yes, but not for years,” Will said. “We can give her those years. And she refuses to let us do it.”
She flattened her lips, drawing herself up to her slight height. “I know such things are emotionally trying for doctors, but they are not medically complicated. The patient’s wishes must come first. You, of all people, know this.”
There was nothing particularly cruel in her voice; that wasn’t in her nature. She didn’t know his history -- he had made sure not to talk about it. She was referring not to his tendency to ignore medical ethics when it seemed necessary.
No, she was referring to his steadfast place as her right-hand man.
She was not assuming that he would make the wrong choice.
She was assuming that he would make the right one.
Having her trust made it easier in some ways, but not in others.
Nothing could make this easy.
“Dr. Halstead,” she said. “Why are you really here?”
If only he knew. If only he could figure it out. If only he could stop coming to this point time and time again. He was always taking one step forward and two steps back, and he was standing on the cusp of disaster or success, and the next step was entirely his choice.
The space between the right thing and the wrong thing was increasingly tenuous, and obligation was not always right. Sooner or later, though, he had to come to terms with the fact that this wasn’t about him.
This wasn’t about what broke him.
This was about what would fix someone else.
And the fact that he didn’t get to decide what that looked like.
If he was going to stand here again, this time he could at least be honest with himself. “Because I don’t want to watch her die,” he said simply. “I’m a doctor, I know how to save her life, and watching her die is hard.”
She creased her brow, inclining her head toward him knowingly. “Hard, yes,” she said. “But it is your job. So, please, do what you came here to do. See it through to the end.”
That was that, then.
Will gathered himself, turned back to his patient. He was here to do a job. He was here to finish what he started. He was here, even when he hated it more than anything else in the world. No easy outs, no quick fixes.
And that was that.
-o-
Back in the ED, the atmosphere had grown quiet. Abena’s room was closed, the DNR sign prevalent. People seemed to be keeping their distance, but that was not a luxury Will would allow himself. If he was going to do this, he was going to do it right.
Letting himself back into the room, the family looked to him. He came over, smiling gently. “Is there anything you need?” he asked. He looked to Abena, and then Eliud and the girls. “Anything at all?”
Abena smiled back at him, worn and relieved. “No,” she said. “You have done enough.”
Eliud closed his eyes, squeezings his girls closer to his side as he said nothing.
Will nodded, the thickness in his throat making it hard to breathe. “I’ll be over there,” he said. “If you need anything -- anything -- just let me know.”
He drew away, as far as he could while staying the same room. He wanted to give them privacy in these last moments, but he didn’t dare stray far. Abena’s heart function was slowing. Her oxygen levels were starting to drop. It wouldn’t be long.
A life reduced to minutes.
Potential contained in moments.
Her husband stayed near, resting each girl on the bed. They talked about what they had done the previous weekend, about the things they had wanted to do the next. Someone would have to feed the goldfish. The girls were learning to help make breakfast. It was okay. It was going to be okay. They hugged; they cried. They told each other how beautiful they were. And they loved each other so very, very much.
They never said the words, but this was goodbye. This was closure. This was acceptance. This was the realization that a thousand options were whittle down to one, down to none.
“I’m sorry,” she said.
And he kissed her. “I know.”
When life was a series of chances you couldn’t control, sometimes taking control over the ending seemed like enough.
Even when it wasn’t.
Abena’s breathing started to struggle. Her heart started to stagger. Will came over, checking the monitors. He offered her an oxygen mask, but she pushed his hand away and reached for her husband and her girls. She took them up, one last time, and smiled.
Then, she was gone.
She fell back, eyes closed. The monitors were silent, but a rapid flurry of her heart was followed by stillness.
Will reached down, checking her pulse with his fingers, the necessary routine he needed to see this through.
He glanced to the nurse who was waiting nearby.
“Time of death 2:55 PM,” he announced softly.
In the silence that followed, Will turned off the monitors. He stepped back to give the family some space, ready to make an inconspicuous exit. In his wake, Eliud stepped forward again, grasping at Abena’s body. And then, bereft, he started to wail. Deep and keening, he buried his head against her. The grace of her passing was a stark contrast to the depth of his loss. The two girls looked confused, but Eliud was not able to help them now. He was sobbing, gathering up his wife’s body, and the nurse finally stepped in, pulling the two young girls back to the side of the room. They looked scared more than anything; lost.
It wasn’t their choice. They didn’t get a say.
And yet, it was these people who had to live with the aftermath.
The choices you made in isolation were the ones that other people bore the brunt of.
How many people had Will hurt? How many choices had Will made without thought of collateral damage? What agony had he left in his wake?
And how much didn’t have to be that way?
He could have saved Abena.
They could have gone home together. They could have been planning for the weekend, not planning a funeral. This family might have still been whole.
It was easier when life and death meant the same thing as right and wrong.
It was easier than this
Because this was raw. This was hurting. This was ambiguous. Actions had consequences -- not just for you but for others.
And did he do it right? Were his instincts right? Was policy correct? Did it matter when so many people were hurting at the same time?
The sense of loss overwhelmed him, and Will realized in a horrible second that he couldn’t do this. He couldn’t stand there and act like he was fine. He couldn’t pretend that following policy made this okay. There was no protocol for grief.
He was feeling hot and light headed. The room was starting to spin, and his eyes were burning. Holding his breath, he moved to the door blindly. “I’ll be right back,” he said to no one in particular, a lie that was more desperate than idle.
Ducking out of the room, he took a hard right away from the central desk area. He avoided eye contact, keeping pace as far away from everyone else as he could. He moved without thinking until he reached the bathroom.
He could hardly see now, his eyes were burning so badly, and he just barely kept himself together long enough to open one of the stalls and lock himself inside. Then, with a rush of emotion he could not longer hold back, the tears started to come.
He didn’t dare cry out, so he grit his teeth as hard as he could to muffle his own sobs. Hot tears streamed out, and he pressed his hands over his eyes in vain to stop them. He didn’t know for sure why he was crying -- he had hardly known Abena -- but the grief he felt was real.
Not just real.
But the realest thing he’d felt in months.
He’d kept himself together so long. He’d maintained composure. He’d held himself tightly in line.
But this? This threatened to undo him. It threatened to break him. It threatened to shatter him and his illusion of self control to pieces.
He couldn’t do this. He couldn’t keep acting like this was a feasible option. He had come here to do better, but what did that mean? How was policy the answer? How was protocol the solution? When it hurt like this?
It was supposed to be better this way. It was supposed to be easier. It wasn’t supposed to hurt so much. The ending was supposed to be happier.
It wasn’t, though. It wasn’t easier. It wasn’t better. And it still hurt -- more than Will could possibly explain.
He wasn’t sure how long he stood there. It took him time to bring himself emotions back into check, and only then, by exhausting them. He didn’t feel better; he had found no relief. There were no answers; there was only the same deep, gnawing doubt that had gotten him to come to Africa in the first place.
Finally, he unlocked the stall and went out into the empty bathroom. At the sink, he paused to wash his face, as if that might help hide the worst of his brokenness. Grief and doubt aside, Will still had a job to do. For the lack of something better to figure out, he would do it at the very least.
When he felt composed -- or at least composed enough -- Will exited the bathroom. Still somewhat bewildered, he made his way back to the exam room to help with anything he could. Before he got there, one of the nurses intercepted him.
“Oh, Dr. Halstead, there you are!” she said.
Will did his best not to flinch. “Yeah, sorry, just stepped out for a second to catch my breath.”
The worthlessness of his lie did not seem to be the relevant concern here. She shrugged it away. “Dr. Dunst wants to see you.”
Will was still feeling shellshocked, but that one caught his attention. “Dr. Dunst? Why?”
The nurse shrugged. “Not sure. But she said it should be ASAP.”
Will looked over to the room where Abena’s family was still grieving.
No doubt, he thought with a pit growing in his gut, this wasn’t over yet.
-o-
This trek seemed familiar. All the times back at Med Goodwin had summoned him upstairs. All the times he’d been reprimanded.
And he still remembered that last time
When she’d fired him without a single word.
Nearly a decade of his life and career, and she’d been unable to even tolerate a single word. He didn’t know Goodwin to be a cruel person. He just knew he’d deserved it.
It felt like he deserved it today, too.
As might be expected, Dr. Dunst looked somber when he came in. She gave him a scathing once over and asked him to sit down.
To call it asking was an exaggeration.
Will knew an order when he heard one.
“After your strange briefing earlier, I felt compelled to review your work more closely today,” she said tautly. “It has not helped that several more nurses came up to see me about this case, invariably upset.”
Will stiffened, but he couldn’t say he was surprised. “I know some of them had a hard time on this one.”
“With reason,” Dr. Dunst said. Her lips were pinched, and she tilted her head. “I know we discussed this briefly earlier, but the facts warranted deeper review. Bear with me as I clarify a few points. I understand your patient was young with a chance of partial recovery.”
“Yes,” Will said. “She came in after a car accident. Spinal injury and heart contusion. Both were operable, but before we took her up, she disclosed that she also has a brain tumor in treatment. Scans were less conclusive that she would ever beat the tumor, but surgery would give her years or the slim chance of more. She still refused, even over objections from her husband and children.”
Dunst nodded along. Clearly, she already had these details of the event. “And then shortly after the matter was settled, she arrested.”
“Yes,” Will said. “Again, we could have taken measures--”
“Measures the patient did not want,” Dr. Dunst said. She looked down the bridge of her nose toward him. “Measures that could have prolonged her life in a struggle she did not want.”
Will had to incline his head. He had girded himself to this truth, but it still tasted unpalatable on his tongue. “Yes,” he said. “I did review the notes from her oncologist. The tumor wasn’t overly responsive and highly aggressive. In some ways, treatment was only delaying the inevitable.”
Dr. Dunst seemed to give one last perfunctory nod. “Well, then, that seems decently explanatory and really much ado over nothing,” she said, shuffling her papers and putting them aside. “I apologize for summoning you up here in such haste and vigor. The concern was unnecessary. You did very good work today.”
It was such a ridiculous response to the situation that Will found himself almost on the edge of humor. He gawked for a moment, shifting in his seat in an attempt to quell the surge of incredulity he felt. “Good work?” he repeated. “I let a patient die today who I could have saved. Who could have lived more of her life, spent crucial time with a husband who loved her and seen her daughters start school.”
Dr. Dunst sat back, returning his look of incredulity with one of her own. “But you did save her.”
Will shook his head, not quite able to gather his thoughts. Normally, with Dr. Dunst, he projected confidence and stability. He didn’t have it in him now. “How? She’s dead.”
In return, she just looked quizzical, nose wrinkled as she studied him. “And you think that a beating heart is the only proof of salvation? What of her wishes?”
“No,” Will said, the objection rising almost like bile in his throat. “She didn’t know--”
“She did know,” Dr. Dunst said. She reached out, picking up the case file again. “Her wishes are surprisingly explicit in this case, as you noted and as everyone else who worked with her noted. She understood completely. Her family is grieved, yes, but that is an unfortunate reality of our jobs. You saved her from her worst nightmare and gave her peace. You did save her life. Is that not what we do?”
The argument was one he’d heard before.
Hell, the argument had been belabored to him time and again. Dr. Charles, Ms. Goodwin, Natalie -- they’d all tried to make him understand.
But none of them had framed it so simply, so plainly, so to the point. Like it truly was a matter of fact.
She wasn’t being cruel. She wasn’t being dismissive.
This didn’t seem like a compromise to her.
It just seemed like the facts.
Somehow, for the first time, the immovable truth he’d spent a career railing against finally seemed to make sense.
He sighed finally, almost laughing lightly. “How do you make it sound so easy?”
Usually, she was simple and to the point, devoid of emotion. But there was a careful quality to her now, something more genuine and true. “I simply know that life is not just breathing. Life is for living, and if a patient is not living the way they wish, then it is a form of death,” she explained. Her lips turned up, almost in a smile. She wasn’t a sentimental person, but her look was almost fond. “There are many ways to die, Dr. Halstead. And some of them happen when your heart is still beating.”
He stood there, feeling the beating of his own heart, and he found himself unable to speak.
“As I said, you did very well today, Dr. Halstead,” she said. “I do not hand out praise lightly, so please, take it for what it is.”
Swallowing hard, he managed to meet her eyes one more time with a nod. “Thank you. Dr. Dunst,” he said. “Thank you.”
She inclined her head as he turned and made his way back out into the corridor. Once he was there, he made it a few feet before the weight of it caught up with him. The life he didn’t save -- or the one he did? It wasn’t for him to say -- it never had been -- and it still defied all his instincts as a human and a doctor.
To save a life. To save a life.
The finality of death was overwhelming when he let himself think about it, and he had spent a lifetime railing against it. Yet, it had come, time and again. He could still remember the faces of the patients he had lost. He had stood up and given the eulogy at his own mother’s funeral. He had been the one to pronounce his own father’s passing.
Yet, what was death if not understood in contrast to living?
And what was living?
The last half year had shown Will that he had no idea what living was. All that he railed against death, but he had failed to understand life in the slightest. All the things he’d taken for granted, all the mistakes he’d made. That wasn’t living. Even now, working all day and retiring to an empty apartment -- the emptiness of it was damning.
Dr. Dunst had a point, then. Will had spent a lot of time the last few years breathing, but he hadn’t spent too much time living. The beats of his heart seemed to be almost wasted, and he was struck by the sudden desire he had to make those moments count.
Not just work; not just serving a greater good.
But life.
Joy and happiness. Meaning and connection.
Sure, he had purpose with his job. He had found meaning by investing in his career.
But joy and happiness? Connection?
Joy and happiness were foreign concepts to him at this point -- lost causes, the both of them. But connection.
All these people in the hospital. All these friendly faces. He had no shortage of options, but he hadn’t opened himself up to the possibility. Since separating from Adam, he’d assumed that isolation was the only solution, but it hardly felt like a solution at all. It felt like death, its own quiet version, pervasive and sinister.
He was dying over here. All the lives he was saving, all the good he was doing -- and Will was dying day by day. Part of him still thought he deserved it, but he thought of Jay back home. He thought of Adam. He thought of Natalie out there somewhere.
And he thought of Dr. Dunst, who needed him to be part of the team.
The first life you save sometimes had to be your own.
Something had to change.
Will thought he might finally know what.
-o-
Knowing and doing were different things. Life necessitated practical applications, and Wil was good at that most of the time. Just not all of the time.
Finding social opportunities was relatively easy. It started by just saying hi to people in the hallways. When they asked how he was, he actually answered, and when they told him about their day, he tried to actually listen.
Then, he forced himself to join the others at the nurse’s station. He didn’t avoid the lounge when it was crowded. At lunch, if there was an empty table, he avoided it in favor of a place among his colleagues.
As awkward as it felt to him, other people seemed to find it quite natural. He was integrated into the social fabric with such ease that he wondered why he hadn’t done it before. Soon, he knew about upcoming weekend plans. He was being invited to house parties. He bought a baby present for a new mother in radiology.
The impact, of course, was more than social. This was how he justified it to himself each night when he went to bed. Being part of the community wasn’t purely self-serving. It offered practical benefits as well.
In the trauma room, he was able to get his point across sooner. The nurses knew him well enough to anticipate his needs. His newfound camaraderie with the wider hospital community allowed him to get better consults, and the diagnostic process was more dynamic when it was shared. He was called in to more traumas as well. Other doctors didn’t mind a helping hand from a friend.
This was how it had been at its best at Med. Back when he and Ethan were still friends, when Connor was still on staff. Back when he and Natalie were the perfect team, and April and Maggie trusted him with their secrets.
Those days seemed like a long time ago, and he didn’t have delusions of bringing them back. The doctor he’d been there -- the person he’d been -- was gone.
He couldn’t forget that.
He wouldn’t let himself forget that.
-o-
Even so, he had to keep building these bridges. If he was going to start over on a whole new continent, then he had to make real connections. These connections were essential for the impact he wanted to make. He couldn’t finish this by himself, no matter how much he wanted to sometimes.
That was how he ended up forming the hospital’s soccer team.
Well, he called it soccer, and everyone repeatedly reminded him that it was football. The fact that he couldn’t get the name right was probably a sure sign that he was the wrong person to organize the team, but the task still fell to him. Two nurses started talking about it, and then a pair of attendings pointed out that the local adult recreational league was open to applications. One of the residents commented how that sounded like so much fun, and wasn’t there a former soccer player working in the lab right now?
Before Will knew it, he had a whole team to field with just one slot open.
Despite the fact that he grew up on baseball, football and basketball, he put his name down.
He’d spent so much of his life just looking out for himself.
But this time, it was about the team.
-o-
The team, as it turned out, was really pretty good. They were adept medical professionals, so Will hadn’t had high expectations on the pitch, but they surprised him. Soon, the hospital’s team was at the top of the league.
The exception was, naturally, Will.
He was still learning the rules of soccer, which was part of the problem. The main issue, however, was just that he wasn’t very good. He had some athletic ability -- he’d grown up playing neighborhood sports and pickup games. In school, he’d gone out for all the teams, even if he was mostly a scrub player. He was best at baseball, if he were honest, but he had the most experience with basketball if only because it was the only sport his brother could trounce him at.
But soccer -- he just didn’t have the footwork. He didn’t have the stamina to run the entire time, much less the dribbling agility to maintain control of the ball. For awhile, they tried him in the backfield, where his lack of dribbling skills was less noticeable, but that only made it apparent how poorly he could clear the field.
To his credit, he tried, though. He never failed to charge the ball, and he wasn’t afraid of colliding with a player on the other team.
Still, work ethic aside, Will knew he was the weak link. In some ways, he was used to it. Sometimes, he actually expected it.
He was constantly sore from games, and he endured several injuries of varying severity throughout the short season. He sometimes thought the team would be better off if he walked away, but he couldn’t do it for the sake of principle alone.
When he sprained his wrist in a particularly gnarly collision in front of his own goal box, one of his teammates nursed him on the sideline. As she wrapped the swollen limb and got him some ice, she smiled at him sympathetically. “You don’t have to keep doing this, you know,” she said.
“Doing what?” Will said, doing his best not to wince as she made sure the bandage was tight to control the swelling.
“Going out there,” she said. “I mean, you take a beating every game.”
He wiggled his fingers reflexively, just to reassure himself that nothing was probably broken. “If I’m dragging the team down, I can sit out more.”
“Oh, no, not that,” she said quickly, and it might be tempting to think she was just being polite but her face was sincere. “This is a rec league. We’re all in it for the fun, and everything thinks the world of you for doing this for us.”
“I know, but I’m clearly not very good,” he said, feeling sheepish now while he watched from the sidelines as his team scored.
She clapped and shrugged all at the same time. “You do know that you don’t have to be good, right?” she said. “It’s supposed to be fun.”
“Right,” Will said, not trusting himself to clap in his current condition. He tried rotating the wrist, hoping he hadn’t just impeded his ability to perform medicine. Dr. Dunst would have his ass for that. He looked at her, remembering the conversation at hand. “And it is fun, right?”
“Yes,” she said readily. “I told you: this is the most fun we’ve had as a staff in years. Dr. Dunst is organized and smart, but...you know.”
“She’s not exactly the most dynamic,” Will said, understanding what she wouldn’t say.
She looked grateful that he’d said it for her. “It’s just nice. To be more than a medical staff. To be a family, maybe.”
“So, then, it’s worth it,” Will said. His wrist still hurt, but he was starting to feel more optimistic about his prognosis now that he was confident his range of motion had not been limited. “We keep at it.”
“But are you having fun?” she asked, hesitating a little. She bit her lip. “I mean, you work hard, and you give it your all, but…..”
“It’s fine,” Will said, frowning a little at the suggestion. “I mean, this is part of being a team.”
“It’s not for everybody, though,” she said. “If you’re not enjoying it or something--”
“Well, soccer -- football -- isn’t my favorite sport,” Will admitted.
“And there’s nothing wrong with that,” she said quickly. “You started this--”
Will nodded. “And that’s the point. I started it,” he said. “And I’ve learned the hard way not to quit.”
Her brows drew together a little. “Even when you don’t like it?”
“You know, especially then,” he said.
“Honestly, Dr. Halstead--”
“Will,” he corrected her quickly.
“Will,” she agreed with a thoughtful nod. “I can’t tell if you’re the smartest man here or the dumbest.”
She wasn’t trying to be mean, and somehow, that just made it the funniest thing Will had heard in awhile. He grinned. “Sometimes I hope those are the same things,” he said. “It’s my only saving grace.”
“Well, ice the wrist and don’t you dare go back in this game,” she said, sternness returning to her voice now. “Don’t you work tomorrow?”
Will looked at his wrist, testing it again. “You think it’ll be a problem?”
“For someone else, probably,” she said. Then she squeezed his elbow. “But for you, I’m pretty sure it’ll be just fine.”
-o-
Will’s wrist was sore for a few days, but he didn’t miss a beat. He covered his shifts, and took on a few extra to boot. He was the first one, dressed and ready, at their next game. He was never going to score, but he didn’t have to.
The team won anyway.
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
-o-
Natalie’s message had been short, but its impact loomed large. He couldn’t get it out of his head the whole night, and it distracted him all throughout the next day. Unable to cope, he pulled back a little. No matter what he did, he couldn’t deny that he just felt sad.
One day became two. Two became a week.
Will couldn’t figure it out. He couldn’t make sense of his own head anymore.
He was doing good work. He was doing something meaningful with his life. He was even making real connections with real people right here.
But something was missing, something he couldn’t quite place and couldn’t quite define.
Something he couldn’t quite shake.
No matter how much good he did, no matter how much of himself he poured out, he couldn’t shake it for a second.
-o-
Then, just to make things fun, Will got a terrible case at work.
Working in an ED, you saw horrible stuff. You dealt with death and pain on a daily basis. He had a front row seat for suffering and tragedy, and he’d been in the game long enough to understand its inevitability. That was why he had to do what he did. He had to stand on the front lines because most people couldn’t fathom it.
There were days, however, when he couldn’t fathom it either.
Yet, he was still expected to face it all the same.
Her name was Abena Gbeho. She was 28 years old, and had a successful career as a teacher in the city. She was married with two young children under the age of five. The family was involved in a car accident, during which Abena incurred most of the injuries. With a broken back and a badly contused heart, Abena needed immediate surgery. That was when she stopped him and took his head.
“No,” she said, locking eyes with him and speaking clearly. Despite her injuries, she had been conscious and coherent for most of her time in Will’s exam room. “No surgery.”
“Abena, I understand that you’re worried, but surgery is necessary,” he said. “Without it, you will never walk again, and your heart will arrest. You will die.”
She nodded, but there was no fear in her expression, not like you might expect from a woman facing paralysis and death. “I will die,” she said. “Now, tomorrow, in a month. I have a tumor. In my brain. It is killing me slowly day after day. I do not want this. No surgery.”
Will was scrambling to keep up now. “Wait, a tumor,” he said. “But your history--”
“It is cancer. We are treating it, but there is no indication that it is going away,” she explained.
“We can do the surgery without interfering with your treatments--”
“I do not want this,” Abena told him, clearly and slowly. “Please.”
“But what is the condition of your tumor? Who is your doctor? We should look at your files--”
“I am done,” Abena said. “No more extreme measures.”
“Abena, I understand your position for end of life care, but your injuries today are fixable,” he reasoned.
“And for what?” she asked. Her hand was gripping his arm now, almost unrelenting in his strength. “To suffer another day?”
“But if your cancer can be treated--”
Her fingernails were practically puncturing his skin now. “I do not want it!” she insisted. “Get my files. Check them. I have a DNR.”
And Will’s whole body went cold. His mind stopped working.
Because his patient, with every chance of recovery, was refusing treatment and had signed a DNR.
Because of course she had.
-o-
A DNR was a big deal in the medical world. When a patient had a DNR, it was indicated on every piece of paperwork. Signs were posted on the door. Every staff member responsible for treatment was briefed.
So if Abena had a DNR, then Will wanted to do this right. This was the exact kind of case that warranted his new by the book mentality around medicine -- and life.
The files provided unequivocal proof of the DNR status, but it was a more complicated history than Will had fully anticipated. Abena would die from her tumor, even if later than probably sooner. Given the progression of the tumor, the death would not be pleasant and the decline would be precipitous. Such situations were the reason DNRs were invented in the first place.
Yet, the file spelled doom, but not immediate doom. Abena’s treatments had successfully slowed the tumor growth. She might have years.
A few years in comparison to a lifetime was still a raw deal, but Abena had young children. If she lived today, she would get to see a few more milestones. She might get to take them to their first days of school. She would build precious memories that they would cherish for the rest of their lives.
To Will, the choice seemed obvious, but there was the rub. It wasn’t up to Will. It was Abena’s life, and it was Abena’s choice. Her delineation of her condition had been apt enough. She seemed to understand the parameters here. If she didn’t want to be treated, then Will had to respect that.
He had resigned himself to that when Abena’s husband sought him out.
Anxious and still bloody from his own stitches, he wrung his hands as he approached. “I’m sorry to bother you, Dr. Halstead,” he said. “My name is Eliud. I am--”
“Abena’s husband,” Will supplied for him. He smiled and offered his hand. “It’s good to meet you.”
Eliud managed a smile, but only just. “I was told my wife had very severe injuries,” he said, glancing anxiously about himself toward the treatment rooms. His wife was in one; his daughters were being stitched for superficial wounds in another. “And I am curious why she has not been taken to surgery.”
Will nodded, even as he had to wince. “I understand your confusion,” he said. “At this point, we’ve done basic triage and identified the worst of her injuries, but Abena doesn’t want the surgery.”
Eliud stared at him for a long, bewildering moment. “She does not want it? But she said her heart is bleeding! She has said her back is broken! These must be fixed, yes?”
“The heart injury will be fatal without surgery, yes,” Will said. He knew from the file that the husband had next of kin privileges. Abena had consented all medical information to be shared between them. “The back injury is harder to pinpoint. Without getting in to look at it, it’s hard to say if she’ll be paralyzed or not.”
Will was trying to keep things as simple as he could -- this man had been through enough already, too much -- but Eliud did not seem to understand. “No, this does not make sense. You must fix what you can fix. The DNR is for the unfixable. Not this.”
“Not according to Abena,” Will said, wishing his answer could be differently. Left up to him, Abena would have been in the operating theater an hour ago, but that wasn’t his call. No matter how much he wanted it to be. “I went over the risks and gains. She was adamant she didn’t want it.”
Eliud shook his head, and he was adamant in his own right. “No, she is not thinking clearly. Perhaps she hit her head, yes? She is not herself.”
That was the kind of out Will would have looked for at most points in his career. He would have been over the case with psych already, searching for a way to override the obvious. He couldn’t, though. His instincts were swelling inside him, and he forcibly ignored them.
It didn’t feel right.
But he knew better.
He held onto that -- with all that he had left.
“I understand that this is very difficult for you, I do,” Will said, and he was emphatic in his sympathy. It wasn’t forced; it wasn’t an act or an affectation. “But I spent a lot of time talking with your wife. She was completely confident that she wanted the DNR applied here -- and that she did not consent to any further surgical intervention for the injuries she sustained today.”
By this point in the conversation, Eliud looked mortified, and he shook his head ever more adamantly. “No, the DNR was for the cancer treatment, not this,” he said, as if he couldn’t possibly understand otherwise. “I want you to save her. We have planned a future together, short though it may be. I am her husband, yes? I have a say.”
“Unfortunately, that’s not really how it works,” Will said. “Abena has put time and thought into her decisions here, and she has every right to decide her own medical care.”
The look of horror deepened on his face. “But she does not have to die!” he said, voice starting to rise. Will looked around, feeling conspicuous and anxious as the familiar pang of doubt started to gurgle in his gut. The husband advanced on him now, away from the room where his daughters were still being stitched up. “The other doctor has explained it to me. There is a sixty percent chance she will live. A fifty percent chance she will walk again.”
As if the odds changed anything. Will hadn’t allowed himself to concretely quantify the odds. The second he’d learned that Abena had a DNR and was refusing treatment, he hadn’t been able to think about it. The odds only confirmed how much this was going to hurt.
“The odds really don’t matter,” Will said. “Abena has not given her consent, and that is her choice.”
“But what is your professional opinion?” Eluid demanded. “You would get the surgery, yes?”
“But it’s not my opinion that matters,” Will argued. “All I can do is give Abena the facts, and she gets to make the call.”
His face contorted, fingers curling into fists. “No!” he said, letting his voice rise. They were drawing anxious looks from other people in the area. “She is not thinking clearly! You must do the surgery!”
The prospect of a dramatic scene was the last thing Will wanted -- the last thing he needed. As Chief of the ED, he was supposed to be in control of things, and right now, he could feel how elusive such control actually was.
“Look, let me review your wife’s case a little longer. We have some time before her condition becomes irreversible,” Will reasoned. “I’ll reassess her prognosis, and go over the options with Abena one more time. Until then, you should spend time with her as well. Tell her how you feel, and listen to what she’s feeling. The best case scenario is the one you two can agree on together.”
It was a sensible course of action, something of a compromise -- even if it did only delay the inevitable. Eluid needed closure, and Will couldn’t give it to him, but Abena could.
Or Eliud could give Abena hope.
Either way, all Will could do was be a doctor.
And he had to let his patients be people.
-o-
He took Eliud back to Abena, and he told them both he’d be back shortly. He had other patients on his service that day, but Abena’s time was pressing. Saying he had an hour was a way to placate her husband.
For Will as a doctor, the timeline was a bit more strenuous.
He had to research her condition, run repeat scans and talk to her oncologist within a very short period of time in order to provide a final case to Abena. He started by sending her back for brain scan, hoping that it might provide more details on her current condition. While the scans were processing, he poured over her files again, tracking her progress from treatment to treatment. He put in a call to the oncologist, who fortunately responded to his inquiry quickly, and she provided a more personalized view of what Will already knew and what the repeat scans were rapidly confirming.
The tumor had been large to start -- and it had been diagnosed when Abena came in with sudden onset blindness. A good portion had been resected in surgery, restoring her sight, but the tumor still remained. With aggressive treatments, including chemotherapy, radiation and a targeted drug cocktail, the tumor’s progress had been slowed, but it was only a matter of time before her functions were affected again.
Everything was on the table.
Sight, language, movement, cognition, memory.
She would never beat the tumor. Abena’s death would be slow, painful and inevitable.
That said, the scans indicated what the oncologist enthusiastically confirmed. That death might not be for years. Her initial prognosis had been bad, but they’d made a lot of headway. With the current plan, Abena could live long enough to see her girls grow up in a real way. There were still good years on the table.
Assuming her current condition could be fixed. The heart injury was straightforward enough, but Will had to admit the back injury was far less conclusive. What if Abena was paralyzed? What if she was unable to walk and condemned to a slow decline? Was that fair? Was it humane?
Reasonable people could disagree, and it didn’t even have to be reasonable. Patient autonomy mattered, and Will had been far too loose with medical ethics for far too long.
It wasn’t his call to make.
So, armed with his talking points, he went back to discuss the matter with Abena one more time.
“Abena,” he said, pulling a chair up to her bedside. They had put her on the slightest of inclines, but due to her injuries, she had to be immobilized and flat on her back. It didn’t help his case, probably, but he was going to try anyway. “How are you doing?”
Abena smiled, and it looked more genuine than it seemed like it should. “Better than you think,” she said. “I asked my husband to step out. He is taking this hard.”
“Which is understandable. It’s a lot,” Will said. He drew a breath, leaving his break thoughtful.
Abena was dying, perhaps, but she wasn’t stupid. “You are going to try to talk me out of it.”
“I just want to go over it with you again,” he said. “I promised your husband I would. As a doctor, I feel compelled.”
Abena sighed somewhat, but she gave a small nod of her head, as much as she was able to while immobilized. “Very well, then. Make your case, Dr. Halstead.”
“I looked at the scans. I reviewed your file. I talked to your oncologist,” he said. “On your current course of treatment, you still have several good years left, maybe more.”
“Years I was looking forward to, yes,” Abena said. “Do not think me callous. I want to be with my husband. I want my girls to remember who I am.”
“And surgery can give you that,” Will said.
“Maybe,” Abena said. “And at a price. You can tell me that I am likely to live, but I know how to read between the lines. There is a good chance I will not walk again.”
“The paralysis is for your lower extremities only,” Will said. “Even if we can’t recover feeling of your legs, we might be able to retain feeling in your pelvic region, which would allow you to maintain some quality of life.”
“But if you cannot,” Abena said. “Dr. Halstead, it is not just each breath we take. It is the way we spend those breaths. If I cannot think and feel and speak, then that is not leaving. And if I cannot walk -- if I am alive only to be carried around until I die -- then, that is not living. I know it is not the choice everyone would make -- not you, not my husband -- but this is the last choice I get to make.”
“Then I have to clarify, one more time,” Will said. “If you refuse this surgery, you will die.”
“Yes,” she said, eyes locked on Will’s.
“And if you do not reverse the DNR, you will not be revived,” Will said, and he knew he was pointing out the obvious, but this was just as much for him as it was for her.
This time, she smiled once more. “Yes, Dr. Halstead. I am myself today. I do not wish to be some fraction of myself. No matter what anyone else thinks or says or believes, I know who I am. And the fear of losing that is more than the fear of losing all the rest.”
That was it, then.
He’d made his case.
He’d laid out the terms.
Now, he had to accept her choice.
Accept her death.
“Okay, Abena,” he said. “No surgery. No resuscitation. Tell me what I can do to make you more comfortable.”
Her smile warmed gratefully toward him. “Just bring me my family,” she said. “One more time.”
-o-
As a doctor, Will was trained to save patients. He’d studied medicine, he’d hone his craft saving lives.
He’d accepted a long time ago that he couldn’t save everyone.
Now, yet again, he was trying to come to terms with the reality that not everyone wanted to be saved.
To be clear, he hated it. It went against all his instincts. If physically pained him to set aside treatments he knew would work and opt to do nothing instead.
Medical ethics didn’t ask what you could do.
It asked what you should do.
When Will’s instincts said one thing, he had to remember that hospital policy said another. Protocol dictated what his instincts struggled to accept.
So Will never booked the operating theater. He never prepped Abena for surgery.
Instead, he gathered her husband and children, bringing them to her room. He increased her painkillers, enough to take the edge off without making her drowsy. He settled down in a corner of the room to monitor her vitals. If this was her choice, then it was his choice, too, and he would see it through -- see her through -- until the very bitter end.
Will was taking it hard, that much was certain.
Eliud was taking it harder.
When Will got him, the man had been nearly silent with his rage. He’d been pale and stiff, barely talking as Will led him back to his wife. Strung so tense, Eliud had been trembling, almost ready to burst.
But then, on the inside, he saw his wife.
And the rage deflated.
In its place was a grief so raw that Will almost couldn’t take it. He came to her, crossing the distance between. Although Abena was immobilized, Eliud took her face in his hands and drew himself closer. He pressed their foreheads together, eyes squeezed close as he breathed her in.
He whispered, in a dialect Will didn’t catch, and then kissed her on the lips.
She returned his kiss, and then whispered an invective of her own, and Will didn’t need to understand the language to know what they were saying.
They were saying goodbye.
After a life shared.
After a love endured.
They were saying goodbye.
The two little girls came close next, and they gathered together -- a family, just how they were meant to be.
Just how they would never be again.
A husband without a wife.
Daughters without their mother.
Will had resigned himself to this, but his heart rebelled -- almost violently. He couldn’t sit idle. He couldn’t.
“If you need anything, the nurse is right outside,” Will said. “And I promise, I’ll be back in a few minutes.”
Abena barely acknowledged him, and Eliud didn’t bother at all. Will slipped out, the feeling of his own fluttering heart loud in his chest. He knew he needed to leave a briefing with the nurse, but he didn’t trust himself to speak. Instead, he cut his way through the ED and up to the stairs. He took them, two at a time, until he reached the administrative floor.
Getting out of the stairwell, he took a hard right turn down a familiar course. Usually, he didn’t choose this path. Usually, it chose him. But this wasn’t about that moment in Ms. Goodwin’s office when she had fired him. This was about something else, and if Will was stuck between policy and his instincts, then he needed someone to change the policy.
Before his instincts broke him.
Fortunately, Dr. Dunst was available, and he had earned enough credibility to request an impromptu meeting. He was allowed inside, and he found her working at her desk.
“Dr. Halstead, you have just caught me,” she said. “I am due over in neurology shortly. They want to impress me with a request for a new imaging machine, but I am not convinced. So whatever you need, I suggest you make it short.”
In his mind, he had come with a reasonable request with logical backing. He intended to be calm, collected and rational.
Standing there, though, the conflict between medical ethics and his instincts as a doctor were too much. Shaking his head, he all but blurted, “My patient has a DNR.”
It wasn’t so much what he said, but the way he was saying it. Dr. Dunst slowed to a near stop, and she looked him over carefully. “Yes, I have heard this,” she said. “I had a pair of nurses in here earlier, expressing how upset they were.”
“Because it’s not fair,” Will said, and all thoughts of rational had eclipsed him now. The strength of these emotions always surprised him, how he could share a grief that he had no part in. “We can treat her, give her good odds for recovery.”
“This case is unique, though,” Dr. Dunst said. “I was told she has terminal cancer.”
“Yes, but not for years,” Will said. “We can give her those years. And she refuses to let us do it.”
She flattened her lips, drawing herself up to her slight height. “I know such things are emotionally trying for doctors, but they are not medically complicated. The patient’s wishes must come first. You, of all people, know this.”
There was nothing particularly cruel in her voice; that wasn’t in her nature. She didn’t know his history -- he had made sure not to talk about it. She was referring not to his tendency to ignore medical ethics when it seemed necessary.
No, she was referring to his steadfast place as her right-hand man.
She was not assuming that he would make the wrong choice.
She was assuming that he would make the right one.
Having her trust made it easier in some ways, but not in others.
Nothing could make this easy.
“Dr. Halstead,” she said. “Why are you really here?”
If only he knew. If only he could figure it out. If only he could stop coming to this point time and time again. He was always taking one step forward and two steps back, and he was standing on the cusp of disaster or success, and the next step was entirely his choice.
The space between the right thing and the wrong thing was increasingly tenuous, and obligation was not always right. Sooner or later, though, he had to come to terms with the fact that this wasn’t about him.
This wasn’t about what broke him.
This was about what would fix someone else.
And the fact that he didn’t get to decide what that looked like.
If he was going to stand here again, this time he could at least be honest with himself. “Because I don’t want to watch her die,” he said simply. “I’m a doctor, I know how to save her life, and watching her die is hard.”
She creased her brow, inclining her head toward him knowingly. “Hard, yes,” she said. “But it is your job. So, please, do what you came here to do. See it through to the end.”
That was that, then.
Will gathered himself, turned back to his patient. He was here to do a job. He was here to finish what he started. He was here, even when he hated it more than anything else in the world. No easy outs, no quick fixes.
And that was that.
-o-
Back in the ED, the atmosphere had grown quiet. Abena’s room was closed, the DNR sign prevalent. People seemed to be keeping their distance, but that was not a luxury Will would allow himself. If he was going to do this, he was going to do it right.
Letting himself back into the room, the family looked to him. He came over, smiling gently. “Is there anything you need?” he asked. He looked to Abena, and then Eliud and the girls. “Anything at all?”
Abena smiled back at him, worn and relieved. “No,” she said. “You have done enough.”
Eliud closed his eyes, squeezings his girls closer to his side as he said nothing.
Will nodded, the thickness in his throat making it hard to breathe. “I’ll be over there,” he said. “If you need anything -- anything -- just let me know.”
He drew away, as far as he could while staying the same room. He wanted to give them privacy in these last moments, but he didn’t dare stray far. Abena’s heart function was slowing. Her oxygen levels were starting to drop. It wouldn’t be long.
A life reduced to minutes.
Potential contained in moments.
Her husband stayed near, resting each girl on the bed. They talked about what they had done the previous weekend, about the things they had wanted to do the next. Someone would have to feed the goldfish. The girls were learning to help make breakfast. It was okay. It was going to be okay. They hugged; they cried. They told each other how beautiful they were. And they loved each other so very, very much.
They never said the words, but this was goodbye. This was closure. This was acceptance. This was the realization that a thousand options were whittle down to one, down to none.
“I’m sorry,” she said.
And he kissed her. “I know.”
When life was a series of chances you couldn’t control, sometimes taking control over the ending seemed like enough.
Even when it wasn’t.
Abena’s breathing started to struggle. Her heart started to stagger. Will came over, checking the monitors. He offered her an oxygen mask, but she pushed his hand away and reached for her husband and her girls. She took them up, one last time, and smiled.
Then, she was gone.
She fell back, eyes closed. The monitors were silent, but a rapid flurry of her heart was followed by stillness.
Will reached down, checking her pulse with his fingers, the necessary routine he needed to see this through.
He glanced to the nurse who was waiting nearby.
“Time of death 2:55 PM,” he announced softly.
In the silence that followed, Will turned off the monitors. He stepped back to give the family some space, ready to make an inconspicuous exit. In his wake, Eliud stepped forward again, grasping at Abena’s body. And then, bereft, he started to wail. Deep and keening, he buried his head against her. The grace of her passing was a stark contrast to the depth of his loss. The two girls looked confused, but Eliud was not able to help them now. He was sobbing, gathering up his wife’s body, and the nurse finally stepped in, pulling the two young girls back to the side of the room. They looked scared more than anything; lost.
It wasn’t their choice. They didn’t get a say.
And yet, it was these people who had to live with the aftermath.
The choices you made in isolation were the ones that other people bore the brunt of.
How many people had Will hurt? How many choices had Will made without thought of collateral damage? What agony had he left in his wake?
And how much didn’t have to be that way?
He could have saved Abena.
They could have gone home together. They could have been planning for the weekend, not planning a funeral. This family might have still been whole.
It was easier when life and death meant the same thing as right and wrong.
It was easier than this
Because this was raw. This was hurting. This was ambiguous. Actions had consequences -- not just for you but for others.
And did he do it right? Were his instincts right? Was policy correct? Did it matter when so many people were hurting at the same time?
The sense of loss overwhelmed him, and Will realized in a horrible second that he couldn’t do this. He couldn’t stand there and act like he was fine. He couldn’t pretend that following policy made this okay. There was no protocol for grief.
He was feeling hot and light headed. The room was starting to spin, and his eyes were burning. Holding his breath, he moved to the door blindly. “I’ll be right back,” he said to no one in particular, a lie that was more desperate than idle.
Ducking out of the room, he took a hard right away from the central desk area. He avoided eye contact, keeping pace as far away from everyone else as he could. He moved without thinking until he reached the bathroom.
He could hardly see now, his eyes were burning so badly, and he just barely kept himself together long enough to open one of the stalls and lock himself inside. Then, with a rush of emotion he could not longer hold back, the tears started to come.
He didn’t dare cry out, so he grit his teeth as hard as he could to muffle his own sobs. Hot tears streamed out, and he pressed his hands over his eyes in vain to stop them. He didn’t know for sure why he was crying -- he had hardly known Abena -- but the grief he felt was real.
Not just real.
But the realest thing he’d felt in months.
He’d kept himself together so long. He’d maintained composure. He’d held himself tightly in line.
But this? This threatened to undo him. It threatened to break him. It threatened to shatter him and his illusion of self control to pieces.
He couldn’t do this. He couldn’t keep acting like this was a feasible option. He had come here to do better, but what did that mean? How was policy the answer? How was protocol the solution? When it hurt like this?
It was supposed to be better this way. It was supposed to be easier. It wasn’t supposed to hurt so much. The ending was supposed to be happier.
It wasn’t, though. It wasn’t easier. It wasn’t better. And it still hurt -- more than Will could possibly explain.
He wasn’t sure how long he stood there. It took him time to bring himself emotions back into check, and only then, by exhausting them. He didn’t feel better; he had found no relief. There were no answers; there was only the same deep, gnawing doubt that had gotten him to come to Africa in the first place.
Finally, he unlocked the stall and went out into the empty bathroom. At the sink, he paused to wash his face, as if that might help hide the worst of his brokenness. Grief and doubt aside, Will still had a job to do. For the lack of something better to figure out, he would do it at the very least.
When he felt composed -- or at least composed enough -- Will exited the bathroom. Still somewhat bewildered, he made his way back to the exam room to help with anything he could. Before he got there, one of the nurses intercepted him.
“Oh, Dr. Halstead, there you are!” she said.
Will did his best not to flinch. “Yeah, sorry, just stepped out for a second to catch my breath.”
The worthlessness of his lie did not seem to be the relevant concern here. She shrugged it away. “Dr. Dunst wants to see you.”
Will was still feeling shellshocked, but that one caught his attention. “Dr. Dunst? Why?”
The nurse shrugged. “Not sure. But she said it should be ASAP.”
Will looked over to the room where Abena’s family was still grieving.
No doubt, he thought with a pit growing in his gut, this wasn’t over yet.
-o-
This trek seemed familiar. All the times back at Med Goodwin had summoned him upstairs. All the times he’d been reprimanded.
And he still remembered that last time
When she’d fired him without a single word.
Nearly a decade of his life and career, and she’d been unable to even tolerate a single word. He didn’t know Goodwin to be a cruel person. He just knew he’d deserved it.
It felt like he deserved it today, too.
As might be expected, Dr. Dunst looked somber when he came in. She gave him a scathing once over and asked him to sit down.
To call it asking was an exaggeration.
Will knew an order when he heard one.
“After your strange briefing earlier, I felt compelled to review your work more closely today,” she said tautly. “It has not helped that several more nurses came up to see me about this case, invariably upset.”
Will stiffened, but he couldn’t say he was surprised. “I know some of them had a hard time on this one.”
“With reason,” Dr. Dunst said. Her lips were pinched, and she tilted her head. “I know we discussed this briefly earlier, but the facts warranted deeper review. Bear with me as I clarify a few points. I understand your patient was young with a chance of partial recovery.”
“Yes,” Will said. “She came in after a car accident. Spinal injury and heart contusion. Both were operable, but before we took her up, she disclosed that she also has a brain tumor in treatment. Scans were less conclusive that she would ever beat the tumor, but surgery would give her years or the slim chance of more. She still refused, even over objections from her husband and children.”
Dunst nodded along. Clearly, she already had these details of the event. “And then shortly after the matter was settled, she arrested.”
“Yes,” Will said. “Again, we could have taken measures--”
“Measures the patient did not want,” Dr. Dunst said. She looked down the bridge of her nose toward him. “Measures that could have prolonged her life in a struggle she did not want.”
Will had to incline his head. He had girded himself to this truth, but it still tasted unpalatable on his tongue. “Yes,” he said. “I did review the notes from her oncologist. The tumor wasn’t overly responsive and highly aggressive. In some ways, treatment was only delaying the inevitable.”
Dr. Dunst seemed to give one last perfunctory nod. “Well, then, that seems decently explanatory and really much ado over nothing,” she said, shuffling her papers and putting them aside. “I apologize for summoning you up here in such haste and vigor. The concern was unnecessary. You did very good work today.”
It was such a ridiculous response to the situation that Will found himself almost on the edge of humor. He gawked for a moment, shifting in his seat in an attempt to quell the surge of incredulity he felt. “Good work?” he repeated. “I let a patient die today who I could have saved. Who could have lived more of her life, spent crucial time with a husband who loved her and seen her daughters start school.”
Dr. Dunst sat back, returning his look of incredulity with one of her own. “But you did save her.”
Will shook his head, not quite able to gather his thoughts. Normally, with Dr. Dunst, he projected confidence and stability. He didn’t have it in him now. “How? She’s dead.”
In return, she just looked quizzical, nose wrinkled as she studied him. “And you think that a beating heart is the only proof of salvation? What of her wishes?”
“No,” Will said, the objection rising almost like bile in his throat. “She didn’t know--”
“She did know,” Dr. Dunst said. She reached out, picking up the case file again. “Her wishes are surprisingly explicit in this case, as you noted and as everyone else who worked with her noted. She understood completely. Her family is grieved, yes, but that is an unfortunate reality of our jobs. You saved her from her worst nightmare and gave her peace. You did save her life. Is that not what we do?”
The argument was one he’d heard before.
Hell, the argument had been belabored to him time and again. Dr. Charles, Ms. Goodwin, Natalie -- they’d all tried to make him understand.
But none of them had framed it so simply, so plainly, so to the point. Like it truly was a matter of fact.
She wasn’t being cruel. She wasn’t being dismissive.
This didn’t seem like a compromise to her.
It just seemed like the facts.
Somehow, for the first time, the immovable truth he’d spent a career railing against finally seemed to make sense.
He sighed finally, almost laughing lightly. “How do you make it sound so easy?”
Usually, she was simple and to the point, devoid of emotion. But there was a careful quality to her now, something more genuine and true. “I simply know that life is not just breathing. Life is for living, and if a patient is not living the way they wish, then it is a form of death,” she explained. Her lips turned up, almost in a smile. She wasn’t a sentimental person, but her look was almost fond. “There are many ways to die, Dr. Halstead. And some of them happen when your heart is still beating.”
He stood there, feeling the beating of his own heart, and he found himself unable to speak.
“As I said, you did very well today, Dr. Halstead,” she said. “I do not hand out praise lightly, so please, take it for what it is.”
Swallowing hard, he managed to meet her eyes one more time with a nod. “Thank you. Dr. Dunst,” he said. “Thank you.”
She inclined her head as he turned and made his way back out into the corridor. Once he was there, he made it a few feet before the weight of it caught up with him. The life he didn’t save -- or the one he did? It wasn’t for him to say -- it never had been -- and it still defied all his instincts as a human and a doctor.
To save a life. To save a life.
The finality of death was overwhelming when he let himself think about it, and he had spent a lifetime railing against it. Yet, it had come, time and again. He could still remember the faces of the patients he had lost. He had stood up and given the eulogy at his own mother’s funeral. He had been the one to pronounce his own father’s passing.
Yet, what was death if not understood in contrast to living?
And what was living?
The last half year had shown Will that he had no idea what living was. All that he railed against death, but he had failed to understand life in the slightest. All the things he’d taken for granted, all the mistakes he’d made. That wasn’t living. Even now, working all day and retiring to an empty apartment -- the emptiness of it was damning.
Dr. Dunst had a point, then. Will had spent a lot of time the last few years breathing, but he hadn’t spent too much time living. The beats of his heart seemed to be almost wasted, and he was struck by the sudden desire he had to make those moments count.
Not just work; not just serving a greater good.
But life.
Joy and happiness. Meaning and connection.
Sure, he had purpose with his job. He had found meaning by investing in his career.
But joy and happiness? Connection?
Joy and happiness were foreign concepts to him at this point -- lost causes, the both of them. But connection.
All these people in the hospital. All these friendly faces. He had no shortage of options, but he hadn’t opened himself up to the possibility. Since separating from Adam, he’d assumed that isolation was the only solution, but it hardly felt like a solution at all. It felt like death, its own quiet version, pervasive and sinister.
He was dying over here. All the lives he was saving, all the good he was doing -- and Will was dying day by day. Part of him still thought he deserved it, but he thought of Jay back home. He thought of Adam. He thought of Natalie out there somewhere.
And he thought of Dr. Dunst, who needed him to be part of the team.
The first life you save sometimes had to be your own.
Something had to change.
Will thought he might finally know what.
-o-
Knowing and doing were different things. Life necessitated practical applications, and Wil was good at that most of the time. Just not all of the time.
Finding social opportunities was relatively easy. It started by just saying hi to people in the hallways. When they asked how he was, he actually answered, and when they told him about their day, he tried to actually listen.
Then, he forced himself to join the others at the nurse’s station. He didn’t avoid the lounge when it was crowded. At lunch, if there was an empty table, he avoided it in favor of a place among his colleagues.
As awkward as it felt to him, other people seemed to find it quite natural. He was integrated into the social fabric with such ease that he wondered why he hadn’t done it before. Soon, he knew about upcoming weekend plans. He was being invited to house parties. He bought a baby present for a new mother in radiology.
The impact, of course, was more than social. This was how he justified it to himself each night when he went to bed. Being part of the community wasn’t purely self-serving. It offered practical benefits as well.
In the trauma room, he was able to get his point across sooner. The nurses knew him well enough to anticipate his needs. His newfound camaraderie with the wider hospital community allowed him to get better consults, and the diagnostic process was more dynamic when it was shared. He was called in to more traumas as well. Other doctors didn’t mind a helping hand from a friend.
This was how it had been at its best at Med. Back when he and Ethan were still friends, when Connor was still on staff. Back when he and Natalie were the perfect team, and April and Maggie trusted him with their secrets.
Those days seemed like a long time ago, and he didn’t have delusions of bringing them back. The doctor he’d been there -- the person he’d been -- was gone.
He couldn’t forget that.
He wouldn’t let himself forget that.
-o-
Even so, he had to keep building these bridges. If he was going to start over on a whole new continent, then he had to make real connections. These connections were essential for the impact he wanted to make. He couldn’t finish this by himself, no matter how much he wanted to sometimes.
That was how he ended up forming the hospital’s soccer team.
Well, he called it soccer, and everyone repeatedly reminded him that it was football. The fact that he couldn’t get the name right was probably a sure sign that he was the wrong person to organize the team, but the task still fell to him. Two nurses started talking about it, and then a pair of attendings pointed out that the local adult recreational league was open to applications. One of the residents commented how that sounded like so much fun, and wasn’t there a former soccer player working in the lab right now?
Before Will knew it, he had a whole team to field with just one slot open.
Despite the fact that he grew up on baseball, football and basketball, he put his name down.
He’d spent so much of his life just looking out for himself.
But this time, it was about the team.
-o-
The team, as it turned out, was really pretty good. They were adept medical professionals, so Will hadn’t had high expectations on the pitch, but they surprised him. Soon, the hospital’s team was at the top of the league.
The exception was, naturally, Will.
He was still learning the rules of soccer, which was part of the problem. The main issue, however, was just that he wasn’t very good. He had some athletic ability -- he’d grown up playing neighborhood sports and pickup games. In school, he’d gone out for all the teams, even if he was mostly a scrub player. He was best at baseball, if he were honest, but he had the most experience with basketball if only because it was the only sport his brother could trounce him at.
But soccer -- he just didn’t have the footwork. He didn’t have the stamina to run the entire time, much less the dribbling agility to maintain control of the ball. For awhile, they tried him in the backfield, where his lack of dribbling skills was less noticeable, but that only made it apparent how poorly he could clear the field.
To his credit, he tried, though. He never failed to charge the ball, and he wasn’t afraid of colliding with a player on the other team.
Still, work ethic aside, Will knew he was the weak link. In some ways, he was used to it. Sometimes, he actually expected it.
He was constantly sore from games, and he endured several injuries of varying severity throughout the short season. He sometimes thought the team would be better off if he walked away, but he couldn’t do it for the sake of principle alone.
When he sprained his wrist in a particularly gnarly collision in front of his own goal box, one of his teammates nursed him on the sideline. As she wrapped the swollen limb and got him some ice, she smiled at him sympathetically. “You don’t have to keep doing this, you know,” she said.
“Doing what?” Will said, doing his best not to wince as she made sure the bandage was tight to control the swelling.
“Going out there,” she said. “I mean, you take a beating every game.”
He wiggled his fingers reflexively, just to reassure himself that nothing was probably broken. “If I’m dragging the team down, I can sit out more.”
“Oh, no, not that,” she said quickly, and it might be tempting to think she was just being polite but her face was sincere. “This is a rec league. We’re all in it for the fun, and everything thinks the world of you for doing this for us.”
“I know, but I’m clearly not very good,” he said, feeling sheepish now while he watched from the sidelines as his team scored.
She clapped and shrugged all at the same time. “You do know that you don’t have to be good, right?” she said. “It’s supposed to be fun.”
“Right,” Will said, not trusting himself to clap in his current condition. He tried rotating the wrist, hoping he hadn’t just impeded his ability to perform medicine. Dr. Dunst would have his ass for that. He looked at her, remembering the conversation at hand. “And it is fun, right?”
“Yes,” she said readily. “I told you: this is the most fun we’ve had as a staff in years. Dr. Dunst is organized and smart, but...you know.”
“She’s not exactly the most dynamic,” Will said, understanding what she wouldn’t say.
She looked grateful that he’d said it for her. “It’s just nice. To be more than a medical staff. To be a family, maybe.”
“So, then, it’s worth it,” Will said. His wrist still hurt, but he was starting to feel more optimistic about his prognosis now that he was confident his range of motion had not been limited. “We keep at it.”
“But are you having fun?” she asked, hesitating a little. She bit her lip. “I mean, you work hard, and you give it your all, but…..”
“It’s fine,” Will said, frowning a little at the suggestion. “I mean, this is part of being a team.”
“It’s not for everybody, though,” she said. “If you’re not enjoying it or something--”
“Well, soccer -- football -- isn’t my favorite sport,” Will admitted.
“And there’s nothing wrong with that,” she said quickly. “You started this--”
Will nodded. “And that’s the point. I started it,” he said. “And I’ve learned the hard way not to quit.”
Her brows drew together a little. “Even when you don’t like it?”
“You know, especially then,” he said.
“Honestly, Dr. Halstead--”
“Will,” he corrected her quickly.
“Will,” she agreed with a thoughtful nod. “I can’t tell if you’re the smartest man here or the dumbest.”
She wasn’t trying to be mean, and somehow, that just made it the funniest thing Will had heard in awhile. He grinned. “Sometimes I hope those are the same things,” he said. “It’s my only saving grace.”
“Well, ice the wrist and don’t you dare go back in this game,” she said, sternness returning to her voice now. “Don’t you work tomorrow?”
Will looked at his wrist, testing it again. “You think it’ll be a problem?”
“For someone else, probably,” she said. Then she squeezed his elbow. “But for you, I’m pretty sure it’ll be just fine.”
-o-
Will’s wrist was sore for a few days, but he didn’t miss a beat. He covered his shifts, and took on a few extra to boot. He was the first one, dressed and ready, at their next game. He was never going to score, but he didn’t have to.
The team won anyway.