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Michael Robinavitch had come to understand three things during his medical career. One, always assume the worst when evaluating patients; don’t let your guard down until you know the full story. Two, be aware of your surroundings, especially during codes. Three, never get attached to your cases, hold empathy and understanding, treat, and move on.
Michael Robinavitch must admit that he was a hypocrite in that sense. He had trouble admitting much of anything these days, to both himself and especially to Jack.
He had felt…suffocated when he left Dennis’s room. He marched, head down, staring at the tiled floor, past the central desk and Dana, towards the staff bathroom. Where he promptly locked the door and let himself sink to the cold floor, head held in his palms.
“Breath, Robinavitch, deep breaths.” His hands shook where they rested against his forehead, gripping into his sparse hair. The shaking spread down his arms until he felt restless where he sat, back against the bathroom door. His breath quickened, his vision swam; how long had he been sitting here?
How long had Dennis suffered at the hands of others? Why didn’t his God protect him? What’s the point of releasing him from here if he’s just going to come right back?
One day, he’ll wake up in the morgue.
His right hand fell from his head, fumbling at his cargo pants pocket, digging at the iPhone that lay inside, silent. He hadn’t managed to calm down at this point, his fingers shaking as he swiped at the screen. Muscle memory took him to his contacts, where he found a name he had relied on so heavily since the Covid pandemic.
You have reached the voicemail of Dr Jack Abbot. If this is a medical emergency…
“Fuck.” He waited for the telltale beep of the voicemail and let out a heavy sigh.
“Jack… Jack, I know I sent you home, but please…please call me back, I need to talk to you.”
He hung up the call and let the phone fall to the ground beside him. Of course, Jack would be sleeping. Robby had been hoping Jack would get as much rest as possible before his shift that night. At the same time, Robby was hateful; he hated that Jack was sleeping while Robby sat on the bathroom floor, wondering how much longer he could lie to everyone in his ER. Then he felt guilt, guilt that he felt this way at all towards Jack. His Jack, who just that morning had peeled off the floor of pedes, had held in his arms while he suffocated on tears.
His Jack, whom he would willingly crawl through hell to find again.
“Robby?” A soft knock on the door above where his head rested startled him out of the panic. Rubbing his sweaty palms against his thighs, picking up his phone, he opened the door slowly. He knew he looked a mess, eyes probably swollen and red, hair disheveled where he gripped it. Dana gave him a pitiful look when he stepped beside her outside the bathroom.
“They’re wrapping up in there. Come sit with me a bit?” She practically dragged him towards the charge desk. While they walked, he fumbled again with the phone.
You have reached the voicemail of Dr Jack Abbot. If this is a medical emergency…
“Please…” is all Robby managed to get out before clicking the red button again, ending the call before it could connect for the second time.
He let his head fall to the raised countertop behind Dana’s computer as the nurse sat before him. His phone came to rest on the counter beside him, silent, no notifications. As devoid of communication as he had been for God knows how long.
“You don’t look so good, kid.” Dana offered to Robby, who could only sniffle and grunt in response. The cold counter felt good against his head. Eventually, he heard Jefferson and Kiara saddle up to the desk beside him, and he let himself stand up again, taking in the two providers.
They didn’t look as horrible as Robby felt; maybe it was a him thing? Maybe this was the thing Jack meant when he said: “You give too much to that place.”
The conversation between the four of them blurred past. Robby knows he piped up at some point and said something frustrating enough that Dana shot daggers at him. He couldn’t remember what, and he couldn’t remember if he should apologize for it. He let his gaze follow Dr Jefferson and Kiara as they adjusted their notes and began to depart from the center of the ER.
“We’ll get started on the 303 process,” Caleb turned the wheelchair to follow Kiara to the elevator, but paused with a knowing glance towards Robby, “come find me at the end of your shift, Robinavitch.”
Robby thought to himself, I'd rather be caught stealing benzos from the med cart than willingly talk about what we just heard in that room. The moment the thought formed, a wave of guilt washed over him, heavy and inescapable.
Dana even got mad at him, not her full rage, but enough to scare him into disappearing into the treatment rooms for the next four hours. He fell into the monotony of test, treatment, and discharge as patients rolled through the doors. It was easy to forget what happened with Dennis earlier, easy to let his mind grow fuzzy and not focus on the bad cases that rolled in. If anyone noticed him avoiding trauma, nobody had the heart or balls to comment on it.
At five, Dana found him leaning against a wall behind South, in the silence of the empty rooms and flickering lights that hadn’t been replaced yet.
“Caleb is looking for you. I recommend you go to him first, Robinavitch.” She disappeared again before he could come up with a witty response. That, honestly, was more humiliating than her coming up and dragging him away by his ear.
So, Robby sucked it up, rolled his shoulders back, and quickly scuttled across the ER and prayed nobody stopped him before the elevators.
Caleb's office sat on the fourth floor, hidden between HR, psychology, and a sad excuse for Home Health offices. The placard on his door read Dr Caleb Jefferson, MD, Head Psychiatrist. Robby didn’t have to guess if he was in the room as the door creaked open under his knuckles.
“Ah, Robby,” Caleb looked up from his laptop, taking in the Attending as he broke eye contact to stare at the rug. He hadn’t been to Caleb’s office in months, maybe even over a year. Caleb gestured for Robby to sit in one of the two chairs before his desk, comfortable recliners in a dusty blue, both having obviously seen as many years as the two doctors had.
“I know you’re hesitant to speak with me; that much has been obvious over our relationship together here in this hospital. But Robby, I need you to understand, I don’t want to speak with you because of something negative. I want to talk with you as both your coworker and friend, because I’m starting to see a pattern that I don’t want you falling into.” Robby shrugs as Caleb continues.
“A pattern I have seen many healthcare workers fall into, and never come back from.”
Robby couldn’t muster the ability to disagree, or even agree if he considered it for a moment. Why had he so willingly come up here? He knew it was easy to avoid Caleb, to placate him with a sad excuse and remind him that not everyone needed help.
He knew it was easy. So why didn’t he this time?
Was it that first day he saw Dennis? Was it Jack’s relapse in pedes that morning? Was it the fact that he felt like he was Dennis?
Maybe it was Covid, when he lost Adamson, or when he lost Leah during Pittfest, or watching his best resident fall into drug addiction.
Maybe it was his inability to do anything at all.
“I want you to feel comfortable opening up to me, Robby. Why don’t we start with why you walked out of the room with Dennis today?”
Am I the sinner?
“It was just…a lot. We hear and see a lot in the ER every day; the worst things have passed through my doors and died under my hands. But that kid…that kid has somehow become the most heartbreaking case down there the last three days, and I’ve seen my staff enter that room as one person, and come out looking completely different. Hell, it happened to me too.”
“Can you explain what you mean by that? What looks completely different?”
“Fuck, I-” Robby rubbed a hand over his eyes, fighting off frustrated tears.
“Dana looks like she finally wants to start doing street team again. Dr Santos helped find him temporary housing, and the kid gave her a gift. McKay says that at some point, she spoke with Dennis, and he told her how to connect better with her son. Jack loves the kid, and supposedly Dennis prefers him, and Jack opened up to him in ways I wish Jack would open up to me. Apparently, three of my other nurses sat with him for hours last night after their shift just to talk about architecture and religion. And all of them, all of them come to me saying how good a kid he is. How receptive, how smart, how capable of living.”
Robby pauses, breathing in deeply as his eyes scrape over the items decorating Caleb’s desk.
“And then I go in there, and I feel scraped raw of everything I am. I feel like I have nothing left to give, nothing left to defend, like he has taken the very essence of me and rewritten it with a knife. I am this ER, I am this hospital; I have sat with patients more bloodied and bruised than Dennis ever will be. And none of them, none of them, have made me feel as broken as he has.”
Robby fears for a moment that laying all of this on Caleb has opened an entirely new can of worms. He’s shaking in the chair, hands pale where they grip the sleeves of his jacket. There are minutes of silence before Caleb speaks again, like the weight of everything Robby had put out there needed to be digested first.
“Thank you for trusting me, first of all, with all of this. Robby, why do you feel like he’s broken you?”
And that alone is a hilarious question to Robby, who huffs a broken laugh at Jefferson. To answer that question would take hours, if not years, of therapy sessions. Working through his childhood and abandonment issues, going into his attachment issues in early adolescence, his anxiety and substance abuse in college, almost losing the love of his life, gaining back the love of his life, and losing his father figure. Slowly becoming the thing he fears the most.
“I am him. I am him, the past, the family issues, the abandonment, the abuse, the bridge. I am him right now, and I don’t know how to tell him that it gets better when obviously, it fucking doesn’t.”
“That’s a lot to hold on to yourself, Robby. Do you think it’s just you that carries this?” Robby shrugs in response, his eyes finally breaking from the trinkets to look at Caleb again. His vision is blurred with unshed tears, and his head is starting to ache with a telltale oncoming migraine. He knows the shift change is soon and needs to get back downstairs.
“Everybody carries that anxiety, Robby. If not out loud, then most healthcare workers carry that fear in silence that the next patient through their door is them. That the next patient they treat will be such a perfect reflection of themselves that they’ll probably relapse, they’ll probably fall back to old habits without realizing it. That is why they talk to us. I know you have hangups about therapy, that you don’t trust it fully, and that is okay. What isn’t okay is letting yourself burn out, letting yourself hold that fear and anxiety so close to your chest you’re crumbling before you can even treat the patient.”
“Dennis is not you. Dennis is not Jack. Dennis is not Santos, Dana, McKay, or any of the other staff who have talked to him during his stay. Dennis is, unfortunately, the product of a lifetime of loss. A loss that has led him to seek out the only source of mental stimulation he has been able to find, which is those bridges. Standing on the brink of death, toying with the universe. I’m not saying it’s appropriate, or hell, even sane, but he’s a kid with a second chance. And your team has given it to him with such grace and dignity that he’s got the choice to seek full-time treatment.”
Robby is fully crying now. The tears won’t stop as he rubs at his cheeks with the sleeves of his fleece. He feels everything starting to come up again, clogging his throat with sobs, hands desperately moving to just stop the tears.
“Michael, you are not weak, and you are not broken. You don’t need to tell him it gets better one day, you just need to set him up to realize it’s a possibility on his own.”
“Okay…I can-I can do that.” Robby nods his head, the headache beginning to bloom behind his eyes. He understands what Caleb is telling him, understands where he needs to go from here (slightly), and understands that he needs to get back downstairs to support the people he knows need it.
“I submitted the 303 request, and it’s still pending. We probably won’t get a judge to sign on it tonight, but I know they might tomorrow before the kid discharges. I need you to talk with Jack about keeping him at least 3 hours past his possible discharge time. Are you feeling okay to go back downstairs, or did you want to talk about something else?”
Robby hesitates. There’s so much he’d like to discuss, if not with Caleb, then with somebody who can dissect it and tell him how to interpret it. Instead, Robby shakes his head, accepting that this conversation is over. Caleb seems to take that in stride, agreeing silently that what Robby had shared was enough for one evening.
“Call me anytime over the next week if you need to talk again.” Robby stands slowly, feeling tingling in tingles to his legs. He doesn’t verbalize an understanding of Caleb's statement; instead, he leaves the room, letting the door shut behind him slowly. A heavy sigh escapes him, leaning his head back against the door, he can feel a physical weight lift from his shoulders even just for a minute.
Fuck, maybe Jack was right about this.
He pulls his phone out, checks the empty notification bar, and presses call one more time.
You have reached the voicemail of Dr Jack Abbot. If this is a medical emergency…
This time, Robby chuckles to himself, hands up the call, and lets himself walk back towards the elevator.
Michael Robinavitch had come to understand four things during his medical career.
One, always assume the worst.
Two, be hypervigilant at all times.
Three, never get attached.
Four, rely on your resources; they’re there for you, too.