Chapter Text
1935
Tav knew smoking was bad for her.
In fact she knew it more than most.
Cardiovascular disease. Lung cancer. Chronic obstructive pulmonary disease. Macular degeneration. Strokes. Heart Failure
Pathology she could reliably expect to come across this nightshift.
Of course she was rota’d to start on nights. She should have expected as much. In her entire career she could perhaps count on one finger how many Black Wednesday’s she had worked in daylight hours.
New computer logins that wouldn’t work. A whole new IT system she had yet to understand – the thirty or so minutes of induction she had received from an overly smiley manager she had received from the trust had done very little to prepare her for tonight.
She wondered briefly whether five years of medical school, foundation training, core training and now a year of higher training would have even prepared her.
Beyond the windscreen of her shitty little hatchback, the hospital loomed in slabs of yellow-white with glare and glass, all hard angles and reflected lights from ambulance lights. Somewhere below she could hear sirens whining in and out of the ambulance bays. It was just before eight in the evening.
St. Balthazar’s University Hospital. Black Wednesday.
The first Wednesday of August when hundreds of brand-new doctors flooded the NHS at the same time. Entire wards suddenly staffed by people who had technically been doctors for around two hours. And the existing doctors rotated round. All lives uprooted. All ties cut. A new department, a new hospital, a new trust.
It was the closest thing medicine had to a national experiment in chaos.
Emergency departments seemed to feel it worst. Every missed cannula ,every uncertain prescription. Every terrified FY1 doctor eventually flowed downhill to A&E.
Tav should have been pleased with herself. She’d spent six weeks trying to get this parking permit. Six weeks of emails, forms, some cursed online portal that only dealt with specific employees with specific car parking news which seemed to constantly forget her login details. It now sat snugly on her dashboard like a trophy for surviving NHS bureaucracy.
Her car smelt faintly of stale coffee, damp fabric and now cigarette smoke. The passenger seat was full of rubbish she hadn’t yet cleared out after the move: two empty Red Bull cans, a sweatshirt that wasn’t technically hers, a stack of printed rota sheets, and the final bill from her old flat .
It was gross. One of the hubcaps was missing. The glovebox didn’t close properly. It suited her.
She took another drag. Her hands were steady enough. That was at least something. She’d been half-expecting them to shake.
This was ridiculous. She knew it. She was thirty-one years old, an ST4 in emergency medicine, not some sweat soaked quivering new FY1 chain-smoking in secret before her first day on the wards. She hadn’t even smoked regularly in years. Only socially. Only when she was drunk. Only when things were bad. Perhaps during a combination of all three.
And things had been very bad.
Long enough, at least, to blow up a relationship, file for an inter-deanery transfer in a fit of wounded pride and raw humiliation, and move from small District General Hospital in the north where she knew every sister and every night porter by name to London, where everything was bigger, brighter, faster and didn’t give a shit whether she kept up or not.
Her ex had stayed of course. That was the worst part. He’d stayed in their shared flat for three weeks after she found out, sleeping on the sofa with all the solemn inconvenience of a man during hardship nobly, whilst she filled in paperwork at the kitchen table and tried not to cry into yet another cup of tea.
By the time her transfer had been approved she’d have moved to the fucking moon if Health Education England had offered her a training position there.
She was here. In London. In a carpark she was paying a small fortune to leave her shitty car in. Smoking like a fucking idiot.
“Excellent,” she muttered at the windscreen. “Just fucking excellent.”
She took a final drag on the cigarette. It didn’t even taste nice.
She wondered how many people she had told to stop smoking with the faint tinge of cigarette smoke on her breath.
That was the saying though, wasn’t it of all good doctors? Do as I say and not as I do.
She crushed the stub out in an empty energy drink can, sprayed herself twice with a body mist she found in the door compartment, and stared at her reflection in the rear-view mirror.
Navy scrubs. Damp hair scraped up. Concealer trying its damned best. Tired eyes, but not hopeless ones.
“You know what you’re doing.” she told herself quietly. “You’ve got this.”
Maybe if she said it out loud, she would believe it.
2005
The doctors office was too small for the number of people crammed into it. But what was a medical handover without a few bums on bins?
Tav stood near the front with a mug of coffee that had somehow already gotten cold between her walk from the doctor’s mess to here.
Handover – somewhere between a clinical briefing and a group therapy session where the day team attempted to explain the state of the department before swiftly fleeing the building.
Next to the board at the front of the room, Rolan, a fellow registrar in navy, began talking. Or rather, performing.
“Cubicle fourteen,” he said, clicking through the patient list on the community, “seventy-eight year old with chest pain who has apparently been ‘awaiting a plan’ since approximately the Tudor period?”
A couple of people snorted awkwardly.
One of the day's juniors, slumped in one of the few chairs with a hollow look of someone who had just existed for too long, rubbed his eyes. “Cardiology said they’d review.”
“Yes,” Rolan said brightly. “Cardiology often says many things.”
He continued scrolling.
“Cubicle nine, clinical appendicitis, eighteen years old, already referred to surgery, though apparently the surgical team would prefer it if the appendix would remove itself, no?”
From the back of the room, another voice chimed. “They won’t see the patient without a CT scan.”
The whole room groaned.
“Who’s the surgical reg on tonight?” Rolan asked.
“Lae’Zel’s on from eight.” Someone replied.
“Oh joy. I look forward to that conversation.” He quipped with a sneer.
It became quite obvious to Tav that Rolan had worked here a while. He knew the systems well, the staff well. She should have been reassured to have someone else on this shift who knew how the department worked, but a small part of her realised how incompetent he would make her look.
As the ritual continued, the day team looked progressively more miserable with every sentence.
“Resus three…” Rolan went on.
“Septic.” Came the answer “Likely chest source. Type one respiratory failure On antibiotics, fluids and hope. ITU is aware.”
“I imagine in their charming way, waiting for the patient to become more interesting.”
Tav shifted her weight and glanced around at the people she’d be working with tonight.
There was Rolan of course. Early thirties perhaps, tall but a little narrow-shouldered. He had the air of someone who was top of his class in med school and hadn’t quite recovered from knowing it.
And then there were the juniors. Most of which did well to hide their nervousness. Some crossed their arms. One nodded their head along to Rolan’s ramblings.
But then there was one that stood out. Small and slight. Eyes that seemed on the very verge of welling up. Hair pulled back in a messy ponytail, though several strands had already escaped around her temple. The ends of it were dyed a faded pink – clearly once bright, but now washed out to a pale uneven rose that suggested that the colour had been applied months ago and quietly surrendered to too many hot showers and too little upkeep.
A yellow badge hung from her lanyard, abutted by enamel pins.
‘Hello my name is: ALFIRA’
Tav made a mental note to keep an eye on this one.
At the front Rolan was still talking.
“... and minors is currently full of people who appear to have mistaken the emergency department for a mildly inconvenient GP appointment,” he said. “I see one gentleman is here because his smartwatch told him to drink more water.”
The day team didn’t laugh. Instead the day registrar finally stood rubbing his face. “Good luck.”
“Thank you,” Rolan replied cheerfully. “We will require it.”
The sunken faces of the day team filtered out of the room like survivors leaving a disaster site.
For a moment there was quiet.
Then Rolan clapped his hands.
“Right, night team. The current department census is about one hundred and fifty which is… impressive even by our standards. So the general approach tonight is simple: put out any fire, and try not to kill anyone.”
A couple chuckled nervously.
“If you're stuck, ask for help. If you think someone looks sick, they probably are. And if there’s a fight in the waiting room, don’t get involved.”
Tav wondered whether that was an issue here.
He glanced briefly at the list again, and the board of names at the back of the office, listing the unfortunate crew of the night shift.
“Oh – and if you have any clinical questions, please feel free to direct them to my fellow registrar, Taz, Tara — “ he squinted at the board, “Tasmin?”
“Tav,” she said automatically. She knew it wasn’t a conventional name, but it was only three fucking letters.
“Yes, that.”
They turned to look at her. Tav cleared her throat.
“Hi, I’m Tav. With the department being this busy tonight, it’s probably worth prioritising early safe decisions, escalating if you’re concerned and safe working, so please make sure you take your breaks–”
“Yes, yes,” Rolan interrupted brightly, clapping his hands. “Right, let's go ruin our lives.”
Alfira looked pale.
Chairs scraped across the floor as the room emptied.
Tav was halfway to the door when she turned to Rolan who was wiping his glasses on his scrub top.
“Quick question.”
He glanced up.
“Do consultants usually come to handover here?”
“Usually,” Rolan said, inspecting his lens before putting his frames back on the end of his nose. “Depends who’s on.”
“And tonight?”
Rolan paused for half a second.
“Not tonight."
Tav frowned slightly. “Right… So who is it? Are they around on the shop floor or —”
“The Vamp—” he caught himself. Tav wasn’t quite sure what he was about to say. “Mr Ancunín.”
The name meant nothing to her, but the way Rolan said it made something of his tone shift.
Tav tilted her head. “And… will he be around if we need him?”
Rolan rose to his feet. “Oh he’ll be around.”
“Good, so if we’re in trouble overnight —”
“You won’t find him chained to the doctor-in-charge desk, if that’s what you’re asking.”
Tav blinked. “Okay…”
“He tends to.. Appear,” he continues, already edging past her towards the door. “Sort of slinks about the department.”
“Slinks.”
“Yes.”
Tav folded her arms. “Does he want to be contacted if something goes wrong?”
Rolan gave a small, humourless laugh.
“Not particularly.”
“So when should we call him?”
“Major incident,” Rolan said.
“And if that happens?”
Rolan shrugged.
“Even then, he’ll only really be interested if there’s a resuscitative thoracotomy going.”
“Wow, insane.” And it was. Perhaps she had been lucky up North. Every consultant she had ever worked with had always been so supportive, particularly to new members of the team.
For the first time Tav noted something unusual: Rolan who had spent the entire handover delivering sarcastic commentary on everyone’s medical practice with the confidence of a man who believed himself the cleverest person in the room, looked faintly uneasy.
He straightened.
“You’ll see.”
“That’s not ominous at all.” Tav muttered.
Rolan gave her a brief look that was somewhere between pity and amusement.
“Good luck, let’s hope you won’t have to call him,” he said before slipping out into the corridor without a backward glance.
What a bellend. She thought to herself.
She shrugged it off.
Besides, an alarm was already sounding somewhere down the corridor. The madness of the nightshift had already begun.
2115
Tav tied the final knot and snipped the suture thread with a small pair of scissors.
The man on the trolley winces and she dabbed the last smear of blood away from his cheek.
“That should do it,” Tav said, “Six stitches in the end. Perhaps it’s easier said than done, but try not to get glasses again for at least a week, eh?”
“Yeah, Doc.”
Tav peeled off her gloves and dropped them into the bin. She had done a good job. She always liked facial lacerations. Her favourite part was making sure their eyebrow aligned properly. She also liked the small talk with embarrassed drunk people as she worked.
This man had attended with a spit cheek and a story about someone ‘dropping a pint glass’.
It was a Wednesday night. And not even ten in the evening.
She glanced at a clock on the wall. Nine twenty three.
Apparently Londoners started their fights early.
She finished cleaning up the rest of his face with a damp piece of gauze, before helping the patient to sit up.
“Keep it clean and dry, and get them taken out in seven to ten days time, okay?”
He nodded and shuffled off the bed, clutching his coat and an information leaflet.
Only once he’d gone did Tav take a moment to breathe.
The department outside the resus bay hummed with the usual background chaos – phones ringing, patients coughing, someone vomiting, someone else yelling at security.
All the actual cubicles had been full when the patient came in, so resus had been the only place free with a bed and decent lighting. It had seemed the simplest option.
Now that he was gone, Tav took a moment to look around the bay.
Different departments always organised things differently. It was something that was best figured out in a quiet moment than when shit hit the fan and you were fumbling for an ET tube in a cardiac arrest.
She pulled open the top drawer of the airway trolley to find inside oral-pharyngeal airway adjuncts and laryngeal mask airways mixed together in a loose plastic tray, sizes scattered without any obvious system .
Well that’s dumb. She thought before her hands moved automatically to organise them by size. It took less than a minute.
At her last hospital she’d known exactly where everything was. Every airway trolley, every drawer. She’d worked there for years as a trust grade before entering training. People had known her there. Trusted her. The consultants had asked her for a hand during busy shifts.
She’d felt… competent. Comfortable. In the right place.
Just another thing he had taken from her, she supposed.
“Doctor,”
The voice came from behind her, causing her to jump slightly at the sound.
“Sorry –” she laughed. “You made me jump–”
The woman standing before her was somewhere in her fifties, maybe even older, with steel grey hair yanked back, a royal blue sister’s uniform immaculate despite the fact she looked as if she had been awake since the Crimean War. Her badge read ‘Jaheira’.
“And what are you doing?” A thick Eastern European accent replied.
“I was only –”
“Touching my trolley,” the woman said. “On your first shift.”
Tav flexed her fingers awkwardly at her side, feeling like a child who had been caught with her hand in the biscuit tin.
“Sorry, I didn’t introduce myself. I’m Tav. New registrar.”
“Yes, I gathered you were something inconvenient.”
A shudder of cold ran down Tav’s spine. She willed her bottom lip not to shake.
“This is my last nightshift of five, and I haven’t murdered anyone, so let's not make tonight the exception, shall we. If you need anything from resus, ask. If you don’t know where something lives, ask. If you touch my trolley again, I’ll take your hand off at the wrist and put it in the clinical waste bin.
There was a beat. A nurse at the station opposite stifled a giggle.
“Understood.”
“And why,” she asked evenly, “ are you using a resus bed for minor injuries?”
Tav felt a warmth hit her cheeks. “All the cubicles are full,” she said quickly, not liking the sound of her voice at that moment.”It was just a quick procedure and I needed decent lighting.”
“I don’t care.”
The words were flat.
“This is resus. Not your personal treatment room.”
Tav opened her mouth, only to close it again.
“What happens,” Jaheira continued, “if a major trauma arrives whilst you're stitching up someone who’s been in a bar fight?”
“I would’ve moved – “
“You would’ve been in the way.”
The silence that followed felt heavy.
“Sorry, I won’t –”
“Don’t apologise. Just don’t do it again.”
She turned, walking back toward the corridor. The conversation was over, she clearly had more important things to do.
Tav stood there a moment, absorbing her first public flaying. Not sure she’d ever been just openly threatened like that at work before.
Excellent. Strong start dickhead.
Once again, she glanced at the clock.
2152
It was gonna be a long night.
0126
Tav sat at the doctor’s desk with one elbow propped on the surface staring at the computer screen. It had been the first time she had time to form a single thought without being interrupted by nurses needing someone to look at an ECG, or juniors lingering for advice.
The patient list stretched down the page in a depressing column of names and numbers. Somewhere behind her a monitor was beeping steadily, and someone in triage down the corridor was loudly explaining that a paper cut did not qualify as life-threatening.
Her current problem to solve sat in cubicle twelve.
Eighty-four-year old female. Fall in her own home. Alert. No obvious injuries. Slightly confused, otherwise stable.
Bloods back.
Sodium 120.
Tav clicked through the trust intranet, scrolling through the ED guidelines.
Hyponatraemia management.
There was always a guideline, usually several contradicting ones. Most of them were written in a language that the author hadn’t set foot on the shop floor in years.
She leaned back, frowning at the wall of text. Not even a flowchart.
Calculate serum osmolality… urinary sodium… fluid restriction depending on cause…
Right.
Whilst the next page loaded, her attention drifted sidewards.
The doctor sitting next to her hadn’t been there a moment ago.
He was tall – noticeably so even when sitting down – and built in that slightly unfair way that made scrubs look better than they had any right to. The pale blue fabric stretched neatly over his broad shoulders. The sleeves of his undershirt were sensibly pushed up at the elbows and he had the relaxed posture that suggested someone who had already been awake for far too long, but wasn’t particularly bothered about it.
His shoulder length hair was pulled back loosely at the crown, a few strands escaping around his temples. There was a shadow of stubble along his jaw.
Tav blinked.
Well.
That was… encouraging.
He was typing something on the computer beside her, long fingers moving quickly over the keyboard.
She studied him for a moment longer than strictly necessary.
Tall.
Handsome.
Calm.
Not bad at all. Maybe this job wouldn’t be entirely miserable. Maybe London wasn’t just chaos, unsupportive seniors, terrifying nurses and public humiliation.
Maybe she’d find a friendly face here. A sympathetic ear. A shoulder to cry on. A lap to bounce on.
At that exact moment, the man turned his head. Their eyes met and he smiled. It was warm, easy, and unexpectedly charming. And with it Tav felt something in her stomach do a small traitorous flutter.
Oh. Maybe this wouldn’t really be all so bad —
His gaze dropped to her screen.
“Ah!” she said brightly at once. And with it everything changed. “You’re looking at hyponatraemia.”
Tav opened her mouth. “Yes…” she said cautiously.
“Well, that’s fascinating,” he continued, swivelling in his chair slightly to face her directly. “Hyponatraemia is one of the most misunderstood electrolyte disturbances in clinical medicine. Probably because it’s not an exciting as magnesium or sexy as potassium –”
In all Tav’s years of practicing medicine, she had never heard someone call potassium sexy.
“-- You see, people focus on the sodium itself rather than the underlying water balance –”
She blinked.
He was still talking.
“ – Which is of course entirely the wrong way to approach the physiology, because sodium concentration is really just a reflection of the relative distribution of total body water between compartments –”
The worlds were coming quickly now. Alarmingly so.
“ – So the critical question isn’t ‘what is the sodium’ but ‘why is it represented as being low’; and that is where things become really interesting, because you have hypovolaemic causes, euvolaemic causes, hypervolaemic causes –”
Tav stared at him.
She had the sudden and overwhelming sense she had been trapped in a lecture theatre she had not consented to enter. A lecture theatre that was burning down.
“--and of course the danger, particularly in the elderly population, is correcting too quickly, because of osmotic demyelination is –”
“Oh,” Tav said out loud suddenly.
The realisation clicked into place with the force of a little old lady falling in her own home.
This wasn’t just a random hot doctor. This was a med reg.
The man paused mid-sentence and smiled again, clearly pleased.
“Ah– yes. Sorry, I should introduce myself.”
He held out a hand.
“Gale. Medical Registrar.”
Tav shook it automatically. “Tav,” she said. “ED Reg.”
Gale nodded enthusiastically.
“And your patient with the sodium of one twenty – have you checked serum osmolality yet? Because the diagnostic pathway really hinges on distinguishing between true hyponatraemia and pseudohypotraemia—"
Tav felt the flutter in her stomach shrivel into something else entirely.
Nerd.
A very attractive nerd.
And thank god he was. Tav wasn't planning on looking much deeper into this sodium business, she already knew she was admitting her under the medics. Thank goodness the medics were as clever as Gale, because it was one in the morning and frankly she found it hard to give much of a shit beyond the initial management.
But still. The ick had announced itself rather proudly.
She nodded politely anyway, because he seemed genuinely nice, and because she welcomed the advice from the hot electrolyte wizard.
“Yes,” Tav said carefully. “Please continue.”
0253
The ambulance doors burst open with a metallic crash that echoed halfway down the corridor.
Tav looked up instinctively. This must have been the pre-alert.
The nurse beside her didn’t.
She was already moving toward the resus bay with the kind of efficient stride that suggested she’d heard that exact sound a thousand times before. Tav followed, tugging a pair of gloves from the box as they stepped into the bright, clinical light of resus.
The nurse was a few inches shorter than Tav, but carried herself with the sort of calm authority that made people move out of her way without question. Her dark hair was tied back into a tight braid that hung neatly down her back, not a strand out of place despite the chaos of the shift. Her uniform was immaculate, sleeves rolled neatly to the elbows.
Her expression rarely changed. It wasn’t unfriendly, exactly. Just economical.
As the distant rattle of a trolley approached, she leaned slightly toward Tav and spoke quietly out of the side of her mouth.
“Watch.”
Tav glanced at her. “Watch what?”
The nurse tipped her chin toward the ambulance entrance.
Two paramedics were pushing a trolley through the doors.
The first was impossible to miss.
She was tall, broad-shouldered and built like someone who genuinely enjoyed lifting people for a living. Her cherry red hair had escaped whatever bun she’d attempted at the start of the shift, curls bouncing wildly around her face as she pushed the trolley forward with infectious enthusiasm.
Beside her walked a second paramedic who looked as though he’d stepped out of a recruitment poster. Tall, composed, dark hair neatly trimmed, uniform still somehow crisp despite the job. Where the first radiated chaotic energy, he moved with the calm steadiness of someone used to balancing that chaos.
The nurse beside Tav sighed quietly.
“You see those two?” she murmured.
Tav nodded.
“They’re about to tell you a story about how they found the patient.”
“That’s usually how handovers work, no?”
“They’ll tell you some completely ridiculous story about how they found the patient,” she murmured. “Or how they had to scale a building, or break down a door, or drag someone out of a burning caravan. It always involves breaking something”
“Well that sounds exciting.”
“And then at the end,” she continued. “They’ll say the patient has sepsis.”
Tav snorted softly. The nurse shrugged.
“It is almost never sepsis.”
The trolley rolled into the bay.
The red-haired paramedic spotted the nurse immediately and lit up like a lighthouse.
“Well if it isn’t my favourite nurse!” She was all brilliant teeth.
The nurse’s expression didn’t change.
“Karlach.”
Karlach beamed.
“You wound me, Shadowheart.”
Must have been a nickname, no?
Karlach gestured proudly at the trolley as she wheeled it to a stop.
“Brought you a spicy one.”
Beside her, the second paramedic nodded politely to the nurse and then to Tav.
“Evening,” he said. “Wyll.”
Karlach leaned sideways to look at Tav more closely.
“Oho.”Her grin widened. “Fresh meat?”
Tav folded her arms lightly.
Karlach slapped the trolley rail happily.
“Oh excellent! Another Black Wednesday victim!"
“We passed a junior doctor crying in a cupboard on the way in,” Wyll added almost conversationally.
“Very emotional scene.” Karlach nodded solemnly. “I only went in there looking for a blanket for the patient, found a lass having a full on Code B”
“Code Breakdown. Of the mental variety”
Tav made a note to check on Alfira later.
Shadowheart nodded her head to the patient on the stretcher between them.
“Oh don’t worry about him, he’s deaf.” Karlach explained.
“No, handover, Karlach mate.” Wyll laughed.
“Karlach straightened immediately, though the grin remained.
“Oh right. Good story actually.”
Shadowheart closed her eyes for half a second like someone bracing for impact.
Tav leaned against the bed, already amused.
Karlach launched into it with enthusiasm.
“So we get the call — elderly male, shortness of breath, possible collapse. Address is this absolutely cursed tower block.”
“Lift broken,” Wyll added calmly.
Karlach pointed at him.
“Obviously the lift is broken. So we haul all the kit up to six flights.”
“Four,” Wyll corrected.
Karlach waved dismissively.
“Felt like six.”
“Neighbour says the patient hasn’t been seen all day,” Wyll continued.
“So we knock on the door,” Karlach said.
“No answer.”
“Knock again.”
“Still nothing.”
Karlach leaned in conspiratorially.
“So naturally…”
“You kicked the door open,” Wyll said.
Karlach raised a finger.
“Heroically.”
“Violently,” Wyll corrected.
“Heroically.”
The patient on the trolley coughed weakly under the oxygen mask.
Karlach gestured proudly.
“So we find him halfway down the hallway looking like he’s just run a marathon through soup.”
“Severe shortness of breath,” Wyll translated.
“Chest sounding rough,” Karlach continued. “Like a haunted accordion.”
“Productive cough,” Wyll added.
“We had to drag him out past the kitchen table,” Karlach said.
“Carefully manoeuvre,” Wyll corrected.
“Complex extraction.”
“Moderately inconvenient hallway.”
Karlach finally gestured triumphantly at the patient.
“Anyway.”
She paused dramatically.
“Very sick when we got there. On fifteen litres of oxygen. Initially a NEWS of 10”
Shadowheart and Tav both waited.
Karlach finished confidently.
“Probably sepsis.”
Shadowheart didn’t even blink.
Tav glanced sideways.
Shadowheart raised one eyebrow.
Told you.
0522
The waiting room looked somehow worse than it did an hour ago, despite how hard everyone was working.
Tav had stepped just inside the double doors and glanced around, patient notes in hand.
Every chair was full. People sat hunched forward clutching limbs, tissues, plastic bags. The television in the corner was playing a day time telly quiz show to absolutely no one’s interest.
“Yonas Parker!”
No one moved. She tried again, a little louder. Still nothing.
Tav sighed quietly and scanned the room again.
Near the vending machines a girl in a glittery silver dress sat crying softly into her phone. She had one heel on, the other show lay abandoned under the chair next to her. Her knee was visibly swollen and already turning an impressive shade of purple.
Not a single friend in sight.
Tav suspected the evening hadn’t ended the way the girl had imagined when she’d put that dress on.
Behind the reception desk, the receptionist reached up and tapped the digital board.
The room went momentarily quiet.
The number changed.
Current wait time: 8 hours
The groan that followed rippled across the room like a wave.
Someone swore loudly. Another man dropped his head into his hands. The girl with the broken knee began crying harder.
Tav rubbed the back of her neck.
Black Wednesday.
A raised voice cut through the waiting room. “This is a fucking joke! Eight hours! I’ve been here three already!”
Tav glanced towards triage.
A drunk man in a crumpled hoodie was leaning halfway over the reception desk, jabbing an accusatory finger towards the triage behind the glass, who looked utterly unmoved by the performance.
“You people don’t care! I could have died by then!” he was yelling.
“You are currently shouting,” the nurse replied, almost bored. “Which suggests otherwise.”
The man opened his mouth to continue his argument. Tav almost took a step forward to help de-escalate the situation, but before she could, a large shadow moved into Tav’s line of sight. The security guard with MINSC stitched into the breast of his black polo shirt stepped forward with slow, deliberate calm.
He was enormous. Easily six and a half feet tall, and built like a brick shithouse. His shaved head was marked with faded tattoos curling around his head and down the side of his neck. The fabric of his shirt strained slightly across his shoulders as he folded his arms.
He looked down at the man in the hoodie with patient interest.
“My friend,” Minsc said gently, his voice surprisingly calm, “you are currently shouting at the triage nurse.”
“Well yeah, because—”
“This is unwise.”
The man blinked up at the giant.
“The triage nurse is very powerful,” Minsc continued gravely.
“Oh yeah? What’s she going to do about it! What are you going to do about it?”
Minsc considered this carefully.
“I will ask you politely to sit down.”
The man laughed loudly.
“Or what?”
“For example,” Minsc said calmly, “this.”
The man shoved past him toward the desk again.
In one smooth motion Minsc stepped forward, caught the man’s arm and turned him neatly into a safe hold that pinned him against the wall without apparent effort.
The waiting room collectively leaned forward.
“Calm now,” Minsc said, speaking to him as though addressing a startled horse. “We breathe. We do not shout.”
The man twisted violently.
And then, before anyone could react—
He bit him. Hard. Minsc merely shook his head as if disappointed.
There was a brief struggle before he guided the man toward the exit doors with steady patience.
“Come now,” he said mildly. “We go outside.”
Tav watched the entire thing with a slow blink.
Once the man was firmly being escorted out, she stepped forward slightly.
“Minsc.”
He paused and turned back.
“Yes, doctor?”
Tav pointed at his forearm where the bite mark was already visible.
“You should probably book in.”
“For what?”
“For that.”
Minsc looked down at his arm thoughtfully.
“You’re going to need antibiotics and a tetanus vaccination,” Tav said.
He inspected the bite again.
“I am still on antibiotics from the last time.”
Tav stared at him for a moment.
Then she shook her head slowly.
“…That’s not reassuring.”
Minsc nodded gravely and continued escorting the protesting man out through the doors.
The waiting room settled back into its usual low murmur.
Tav took a breath, glanced at the patient list, and raised her voice once more.
“Yonas Parker!”
0658
The ambulance doors burst open with a crash that cut through the department.
“Patient into resus.” came the voice over the tannoy.
The trolley came in fast.
The patient on it was already upright, half-sitting against the straps, gasping for air with the panicked, animal look of someone who could feel themselves drowning. Her skin was grey and damp, sweat soaking through her nightdress.
“Sixty-four-year-old female,” the paramedic said quickly as they rolled into the bay. “Shortness of breath worsening all afternoon. Daughter called when she started getting confused. Productive cough. Sats seventy-six on air when we got there.”
The oxygen mask fogged with each ragged breath.
Tav was already moving.
“Across to the bed.”
The trolley slid against the resus mattress and the team shifted her over.
Tav’s brain slipped into the familiar rhythm of the A to E.
Airway.
The woman was conscious, choking on air but talking in broken words. There was no stridor.
“Airway’s patent,” Tav said.
Breathing.
The respiratory rate on the monitor shot up as the leads went on. Thirty-eight.
Her chest heaved violently with every breath.
“Let’s get a non-rebreathe mask on. Fifteen litres.”
Shadowheart was already reaching for the tubing.
“Chest sounds awful,” Tav continued, leaning over with the stethoscope. “Crackles throughout. Sats?”
“Eighty-two.”
Circulation.
Tav’s fingers found the pulse—fast and thready. Her heart rate was more than a hundred and twenty, easy.
“BP?”
“Seventy-nine systolic.”
“Okay. Two large-bore cannulas. Bloods, cultures, VBG.”
The printer spat out the blood gas strip minutes later. Someone thrust the paper into her hand.
Lactate raised at 5.4, pH dropping.
Septic shock, her brain said immediately.
Disability.
The patient was drifting now, eyes unfocused.
“Margaret, can you still hear me? Can you squeeze my hand?”
The woman groaned but gave Tav’s hand the weakest of squeezes.
Exposure
No rash. No obvious trauma. No obvious bleeding. No abdominal tenderness.
“Right,” Tav said, straightening,”This looks like septic shock. Let's keep going with the fluids. Let's get some broad-spectrum antibiotics going.”
Shadowheart glanced up. “What do you want?”
“Co-amoxiclav and clarithomycin please.”
“Already prescribed?”
“Doing it now.”
The team moved around her with brisk efficiency. Cultures drawn. Fluids hung. Catheter inserted.
The oxygen mask hissed loudly over the patient’s desperate breathing.
Tav listened to her chest again. Wet crackles everywhere. The slightest of wheezes bilaterally.
The patient coughed weakly into the mask. Pink foam streaked the plastic. Tav frowned but kept moving. “Another fluid bolus,” she said. “She’s still hypotensive.”
For a moment the room moved with her. Instructions. Hands moved. Lines appeared. The quiet choreography of resus unfolding around the bed.
Tav felt the familiar rhythm settle in.
This part of the job had never frightened her. In fact, it had been the thing that had pulled her into emergency medicine in the first place. The moment when a patient arrived grey and gasping and the room sharpened into focus – when everyone had a role, when decisions mattered, when there was something practical and immediate you could do to help.
She liked that; liked the urgency of it. The clarity.
A sick patient wasn’t an abstract problem. They were right in front of you, and if you thought carefully, worked quickly, and trusted your training—you could change the trajectory of the next hour of their life. Sometimes even the rest of it.
There was something deeply satisfying in that.
The quiet reward of watching the numbers improve on the monitor. The moment a patient who had arrived terrified and drowning in air suddenly found their breath again. The knowledge that your hands had done something real.
It was why she came to work.
Why she’d stayed in the job through endless night shifts and bad coffee and the grinding exhaustion of training. Because when it worked—when you got it right—it mattered. You saved people.
Different hospital, different faces, sharper accents and quicker tempers—but the medicine was the same. Airway, breathing, circulation, disability, exposure. Look at the numbers. Think. She had done this before.
Back in the North she had run resus calls in crowded corridors, in cubicles that were far too small, once even in a plaster room when the department ran out of space. The culture had been different there—more relaxed, more forgiving—but the work itself was the same.
A sick patient was still a sick patient. And Tav was still a good doctor.
For a moment the department stopped feeling like an enormous, hostile machine she’d been dropped into.Just a bigger version of the same job she’d always done.
It felt familiar. Manageable. Maybe she could do this after all. Maybe she could survive here.
Then a voice spoke behind her.
“Tell me.”
Cool. Smooth. Controlled.
“Is there a clinical reason you’re attempting to drown her?”
The air changed. The bay had gone silent in that dreadful way hospital spaces did when everyone was pretending not to listen.
He stood just outside the bay with his hands in his pockets, posture so relaxed it was almost insolent. He wasn’t particularly tall, maybe a few inches more so than herself, but there was something large about him. Every line of his lean body was precise and elegant. Pale hair swept back in curls effortlessly from his face, catching the harsh clinical light of the resuscitation room. His cheekbones were high and cut like glass, hip upper lip twitching slightly in a sneer.
And his eyes – Cold. Assessing. Sharp. Beautiful.
Of course his scrub top was immaculate, his consultant badge gleaming against it.
Mr Astarion Ancunin
He looked at the patient. Then the monitor. Then the fluid bag. Then Tav.
“Well?” he said.
“She’s septic,”Tav replied. “Likely pneumonia. Hypotensive, raised lactate—”
“Yes, I can read. A rare gift in this department, but not unique.” he said. His voice was quiet. That made it worse. “What I’m asking,” he continued, “is whether you can.”
Heat climbed slowly up Tav’s neck.
“I’m managing presumed septic shock.”
“No,” Astarion said calmly. “You’re not.”
He stepped forward and listened to the patient’s chest for barely three seconds. Then he straightened.
“Stop the fluids.”
Shadowheart didn’t hesitate.The line was clamped.
Tav stared at him. “What?”
“She’s drowning,” Astarion said.His tone remained almost bored.“Crackles to the apices. Pink froth. Rising CO₂ on that gas you’re holding.”
Tav looked down again at the patient.
Now that he’d said it—
The bubbling breaths. The worsening work of breathing. The foam. Her stomach dropped.
“Acute pulmonary oedema,” Astarion continued. “Probably decompensated heart failure, triggered by infection.”
He glanced back at Tav.
“And you’ve just kindly poured a litre of fluid into her lungs.”
The words landed like blows. Tav felt her jaw tighten.
“Perhaps they manage these things differently in whatever tiny rural shithole hospital you transferred from.”
A couple of people shifted awkwardly, pretending not to hear.
“But here,” Astarion said, “we prefer keeping our patients alive.” He shrugged as if it were a novel ideal. “Try treating the patient rather than the guideline.”
His voice never rose. That made it worse. There was no temper in it, no drama to brace against. Just precision. Just contempt filed to a point.
Tav set her jaw. “I was getting there.”
“Were you?”
A pause. Tiny, deadly.
Then he tilted his head, eyes flicking over her scrubs, her lanyard, her face.
“Another pair of navy scrubs,” he said softly. “Just what this department needed.
He turned to Shadowheart. “GTN infusion.”Then to the rest of the team. “NIV.”
The room moved instantly.The oxygen mask vanished. The NIV mask came down over her face. Machines hummed to life.
“Higher PEEP,” he said calmly, not raising his voice.
Shadowheart adjusted the settings without hesitation.
“GTN running,” she said.
“Good.”
He rolled his sleeves up slightly—just enough to expose his wrists—and reached for the arterial line kit.
Tav didn’t realise she was still standing there until Jaheira gently but firmly nudged her half a step aside to make space.
The message was clear.
Out of the way.
She moved automatically.
And watched.
Astarion worked with an ease that was almost irritating to witness.
No wasted movement. No hesitation. Just quiet efficiency. His hands moved over the equipment with the kind of familiarity that came from doing something a thousand times before. The arterial line went in smoothly, the catheter sliding into the radial artery as if the vessel had been waiting for it.
His fingers were long and precise, moving with almost surgical grace.
Tav hated that she noticed.
He secured the line quickly and glanced up at the monitor.
“Let’s see what she does.”
The numbers on the screen flickered. Heart rate still racing.Blood pressure climbing slowly under the nitrate infusion. Oxygen saturations crept upward as the NIV began to do its work.
The woman’s frantic breathing eased slightly under the mask. Astarion didn’t celebrate. Didn’t even comment. He simply adjusted the ventilator with a small turn of his wrist.
“Keep the GTN going,” he said. “Repeat gas in ten minutes.”
Shadowheart nodded.
The team moved around him with quiet confidence. As if this was routine.
As if he had always been the centre of the room.
Tav stood near the edge of the bay, arms wrapped tightly around her. As if she were frightened to even use her hands. She hated this.
Hated the hot burn of embarrassment still sitting under her skin. Hated the way the room had shifted the moment he stepped in, the way the team had naturally fallen into his rhythm.
And she hated—really hated—the sinking realisation that the patient was improving because of him.
The oxygen saturation ticked up.
82… 85… 90.
The ragged panic in the patient’s breathing began to ease under the NIV mask.Astarion glanced at the monitor once more, satisfied, then leaned slightly over the bed to listen to the chest again. He gave a small nod as he did so
Tav told herself to stop watching him. She didn’t. She couldn’t
Her eyes kept drifting back to his hands.
The way he moved—quick, precise, almost elegant. The tendons shifting under pale skin as he adjusted the arterial line transducer. The faint concentration in his expression as he watched the waveform appear on the monitor.
He looked completely at ease in the middle of chaos.As if the department existed purely for him to organise.
It was infuriating.
She hated how beautiful he was under the harsh white lights. Hated how composed he looked. Hated the quiet confidence that rolled off him in waves. And she hated the uncomfortable truth rising slowly in her chest.
She admired him. Just a little.
Astarion glanced sideways.
For half a second his eyes met hers.
Cold. Assessing.
He looked away again immediately, as though she were no longer relevant. The dismissal stung more than the insult had.
Tav looked back at the monitor. The numbers were stabilising now. The patient’s breathing had slowed. The room had relaxed around the bed. And Tav felt something twist uncomfortably in her chest.
She hated him. Hated the way he’d spoken to her. Hated how small he’d made her feel in front of everyone. But watching him work— Watching the effortless precision, the calm authority—
She realised something else. This was the level she was supposed to reach. This was what being a consultant here looked like. And suddenly the department felt even bigger than it had before.
Tav’s fingers clawed at the fabric of her scrub top, it suddenly feeling uncomfortable against her skin.
She had crossed half the country for this job. Left behind the wreckage of one life and arrived here with her stupid fucking parking permit, her boxes, her expensive rent and her brittle little speech about fresh starts. She was an ST4. She had led arrests in a district general with one SHO and a bank nurse and no ICU bed for fifty miles. She was not inexperienced. She was not fragile.
And for the first time since she’d walked into the hospital that evening she felt properly, deeply out of her depth.
Really fucking out of depth.
She felt like she was drowning.
And all she could think about was him.