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VOLUME 4: NIGHTMARE
02:00 AM. ER parking lot.
"Haaa. Fuck."
Ren Hoshino sat on the curb outside the ambulance bay, both hands wrapped around a paper coffee cup that had gone lukewarm twenty minutes ago, and didn't drink from it. His eyes had sunk deep into his skull, dark circles beneath them dark enough to look like bruises. His hair had given up entirely, sticking up in three directions that had nothing to do with each other. His scrub top carried a wrinkle pattern earned by sleeping in it, sitting up, for maybe forty minutes total in the last twenty-four hours.
"You alright, Ren?"
Ren's eyes moved to the man leaning against the wall beside him, cigarette already lit, badge clipped crooked to his scrubs. Josh. ER charge nurse, six years in, arms loose at his sides, shoulders down. A hundred nights just like this one had worn the flinch out of him a long time ago.
"Do I look alright to you, Josh?"
"Hahahaha. Of course you look alright." Josh took a drag, exhaled through his nose instead of laughing outright, and looked him up and down with obvious enjoyment. "You look like shit, is what you look like."
"Thanks for the compliment, dickwipe."
"You're welcome, asshole."
"What are we talking about, senior. Let me join."
Rachel came around the corner from the staff entrance, scrub cap still on, a bob cut framing her face, the small angel tattoo on her forearm catching the parking lot's sodium lights. She dropped down onto the curb next to Ren without asking, close enough that their shoulders touched, and reached over to steal a sip from his cup before he could stop her.
"That's cold," she said, making a face.
"I know it's cold. I've been holding it for twenty minutes contemplating my life choices."
"We're discussing the philosophy of life, Rachel," Josh said, entirely too pleased with himself.
"Philosophy my ass," Ren said.
"Are you cursing out Professor Holmes again, senior?"
Ren spat, deliberate, onto the pavement between his own feet.
"Don't say that old fart's name to me."
"That bad, huh."
"You have no idea." Ren rubbed both hands down his face, dragging his fingers through his already-ruined hair. "We were short-staffed tonight. He puts in a request for an assistant resident from general surgery, says he needs someone with good hand dexterity for a case. And guess who they send."
"You."
"Me. I figured I'd be handing him instruments. Passing sutures. That's it. That's the whole job description in my head." Ren's voice climbed, rehearsed, delivering a complaint that had already been run through once on the walk down here. "I get there and there's four people already in the room. The attending. Anesthesia. Two nurses. I'm not there to hand anybody anything, because Holmes looks at me and goes, 'you're closing.'"
"Closing what."
"The chest. There was a pipe in it, Josh." Ren held both hands up, spread about a meter apart, demonstrating. "Rebar, actually, off a construction site, went in below the clavicle and sat there like a flagpole. You don't just yank something like that out in triage, it might be the only thing tamponading a major vessel, so we had to get him to the OR still impaled, prep the field around it, and pull it under direct vision with vascular standing by in case it opened up something worse the second it came free."
"So you didn't close around it."
"God, no. Nobody closes around a foreign body, that's how you kill someone slowly instead of quickly. We removed it, found the bleeder, repaired it, and then I closed. Holmes did the vascular repair himself. I got handed the needle driver for the chest wall closure after, which still felt like being handed a live grenade."
Rachel was already laughing, quiet, into her own hand.
"It's not funny."
"It's a little funny."
"You want to know what it's like to close a chest wall on someone who almost lost a subclavian vessel an hour earlier? Because I can tell you. It's not fun. Every single suture, I'm thinking about how thin that repair still is underneath everything I'm sewing shut, and if one stitch pulls tension across it, that repair opens back up, and he starts bleeding again where nobody can see it happening until it's too late."
"Dramatic," Josh said, not even looking up from his cigarette.
"I have not slept in nineteen hours. I closed a chest wall over a vascular repair I didn't perform, with an attending surgeon, an anesthesiologist, and two nurses watching me do it like I was auditioning for something. My hands were shaking so bad going in I thought I was going to embarrass myself in front of the entire OR. Holmes didn't say a single reassuring word the whole time. Just stood there with his arms crossed like a judge at a competition I didn't sign up for."
"What'd the guy even hit," Josh asked, genuinely curious now, cigarette forgotten between two fingers.
"Subclavian artery, partial tear. Another few millimeters and he loses the whole vessel, and that arm doesn't get blood flow long enough to matter. Holmes patched it in under twenty minutes once the rebar was out, which is genuinely insane, and then handed the closure off to me like it was nothing. That's the difference between me getting called a resident of the month and me getting called into a mortality and morbidity conference to explain why I let a college kid bleed out on my watch."
"He was a college kid?"
"Twenty. Working a summer job on the site. Nobody even knew the pipe had rebar sticking out of it until he lost his footing and landed on it." Ren scrubbed a hand over his face again, the adrenaline of the retelling finally starting to bleed back out of him, leaving something quieter underneath. "He's going to be fine, probably. Kid's tough. But you don't walk out of a room like that and just, I don't know, go get a sandwich. I stood in the scrub sink for ten minutes after just breathing."
"But you didn't," Josh said.
"I didn't."
"Because you never do." Josh took another drag, grinning around it. "Hahahaha. But you did good, right? Mr. Resident of the Month. Old fart Holmes has been singing your praises nonstop since. Calling you a genius. Says you were born with surgeon hands. I heard one of the attendings actually called you 'god hands' in the doctor's lounge."
"God hands," Ren muttered. "I hate that. I hate it so much. Do you know what happens once a nickname like that sticks? Every attending in the building suddenly wants me on their case. I'm not a person anymore, I'm a hand dexterity party trick."
"Small violin," Rachel said, holding up two fingers and miming the bow.
"You're supposed to be on my side."
"I am on your side. I'm on your side while also finding this extremely funny."
"You know what's funny," Ren said, pointing his cigarette at her. "You've been listening to me complain for twenty minutes and you haven't once told me your night was worse."
"My night wasn't worse."
"See, that's suspicious. You always tell me when your night's worse. It's like a competition with you."
"It's not a competition."
"You brought a whiteboard into the break room once specifically to track it."
"That was a joke."
"You updated it for three weeks, Rachel."
"And that's why Holmes dragged you down here to learn trauma," Josh said, spreading both arms wide, presiding over the ambulance bay like a king surveying a small, unpleasant kingdom. "So. Welcome to hell."
Ren opened his mouth to complain further.
"Don't," Rachel said.
"Hmph."
She pulled a cigarette from her own pocket, put it between his lips without asking, and lit it for him one-handed, the motion so practiced she barely had to look at what she was doing.
"Alright, alright, senior. Stop complaining so much. It doesn't match the face." She sat back, satisfied, watching him with a small, private smile. "You complain like an old man. Contradicts the whole handsome thing you've got going."
Ren exhaled smoke, slow, and let a smirk settle in.
"And that's why you like me, isn't it, princess."
Rachel's ears went red instantly.
"Don't call me that."
Josh clicked his tongue, shaking his head with theatrical disappointment.
"I genuinely do not understand how you pulled the princess of the ER with that homeless-person energy you've got going, Ren. Respect, my brother. Actual respect."
"It's my charming personality," Ren said, "and my godlike face, you absolute retard."
"Hmph." Rachel laughed despite herself, leaning her head briefly against his shoulder.
"You two are disgusting," Josh said, without any real venom in it. "I remember when you first started dating and you'd both deny it to my face like I was an idiot."
"We weren't denying anything."
"Rachel told me you two were 'just colleagues' three weeks after I caught you sharing a single granola bar in the supply closet at four in the morning."
"That was a professional granola bar exchange."
"There's no such thing."
Rachel snorted, unable to hold it in.
For a moment none of them said anything, the three of them sitting in the orange wash of the ambulance bay lights, cigarette smoke curling up into a sky that hadn't decided yet whether it wanted rain. Somewhere past the bay doors, a monitor beeped steady, distant, the hospital's own quiet heartbeat running underneath everything.
"You know," Josh said, conversational, tapping ash off the end of his cigarette, "it's quiet tonight."
Ren and Rachel's faces both went pale at the exact same instant.
"You FUCKER. Don't say the Q word." Ren was already on his feet, coffee cup forgotten on the curb.
"Right, senior." Rachel had gone rigid beside him, one hand already halfway to grabbing Josh's sleeve like she could physically stop the words from having been said. "Josh, are you actively trying to get us killed."
"You two are unbelievable." Josh took a slow drag off his cigarette, unbothered, still not looking up from it. "You people actually believe in that jinx nonsense? Let me tell you something, it's just statistics. It's not."
"It's not statistics, Josh, it's a documented pattern," Ren said, eyes already fixed on the bay doors. "Every single time someone says the Q word on this shift, something comes in within ten minutes. I've tracked it."
"You've tracked it."
"Mentally. In my head. Where the data lives."
"That's not data, Ren, that's superstition wearing a lab coat."
"It's a hypothesis that has never once been disproven."
"Because you refuse to test it properly. You could just, hypothetically, not say the word for a month and see if bad things still happen."
"Ask any nurse in this building. They'll all tell you the same shift pattern."
Rachel, still rigid, eyes locked on the parking lot entrance, didn't even look over. "He's right, Josh. Don't argue with him about this. You'll lose and we'll all still be cursed."
"I can't believe I work with two doctors who legitimately think saying a word summons trauma patients."
"Not summons," Ren said. "Attracts. There's a difference."
A siren cut through the argument, distant at first, then closing fast, red and white light sweeping across the parking lot's far wall.
"FUCK. I fucking TOLD you," Ren screamed, already turning toward the bay doors.
Josh's radio crackled against his hip, and for one half second his face actually lost its composure entirely, the cigarette forgotten between two fingers, ash trembling loose and scattering across his shoe.
"Code red. Code red, incoming, ETA two minutes."
Nobody said "I told you so." Nobody needed to. Ren was already moving, half-empty coffee abandoned on the curb where it would sit until morning shift found it, and Rachel fell into step beside him without a word, the two of them crossing the ambulance bay at a pace just short of a run, years of the exact same walk making it look almost casual despite everything underneath it.
Behind them, Josh dropped his cigarette, ground it out under one heel, and followed.