Chapter 6 – Four Interns, One Chest
Bellevue Hospital, Trauma Bay 1 – Day 7 of Intern Year, 22:11
The trauma pager detonates like a bomb in every pocket at once:
MOTORCYCLE VS. TRUCK
UNRESTRAINED DRIVER
DECAPS, BILATERAL CHEST, PELVIS, HYPOTENSIVE
ETA 4 MINUTES
Jamal Carter's voice booms over the overhead speakers: "Trauma team to Bay 1. I repeat, Bay 1. Bring the interns. All of them."
The four of them haven't spoken in four days.
Asher hasn't looked Leo in the eye since the transplant.
River has been surviving on IV caffeine and spite.
Ezra's right hand is still swollen from punching the wall.
Leo hasn't slept in a bed since Tuesday.
Now they run.
They collide in the ambulance bay doors at the same moment, four white coats flapping like surrender flags. Noah Kim is already there, grinning like a demon who just got promoted.
Noah claps once. "Congratulations, babies. Tonight you're all first assists. One chest, four interns, two attendings. Don't kill my patient and I might let you eat this week."
The ambulance screams in backwards.
The rider (twenty-four-year-old named Mateo Castillo) is a horror movie in real time. Helmet half melted into his skull, left leg turned ninety degrees the wrong way, blood pulsing from his groin in rhythmic spurts. His chest is silent on the left (no breath sounds, trachea deviated hard right).
Jamal and Matteo Rossi arrive at the same time, shoulder-checking each other through the doors like rival lions.
Jamal: "Tension pneumo left, get a dart in him!"
Matteo (already gloved): "He's bleeding out from the pelvis. External fixator now!"
For one terrifying second they lock eyes over the patient (alpha vs. alpha, trauma vs. cardio).
Then Jamal laughs, short and sharp. "Fine. You take the heart, I take the bones. Interns—pick a side."
The room explodes into controlled chaos.
Leo finds himself shoved to Matteo's left. Asher to his right. River ends up holding C-spine while Ezra is literally thrown a pelvic binder.
Matteo's voice is ice. "Kang, needle decompression. Now."
Leo rips open the kit with his teeth, slams the 14-gauge into the second intercostal space mid-clavicular line. Air hisses out like a scream. Mateo's chest rises for the first time.
Matteo doesn't praise. He just nods once and slices the chest open with a 10-blade (left anterolateral thoracotomy, no hesitation).
Asher is already there with the Finochietto. They crank together, ribs cracking like gunfire.
Inside: blood, blood, everywhere. The left lung is collapsed and shredded. The heart is barely flickering.
Matteo's hands dive in. "Cross-clamp the aorta. Kang—finger on the descending, press hard."
Leo shoves his hand into the chest, finds the aorta, compresses. His entire arm is inside another human being. Blood is warm and slippery and alive.
On the other side of the drape, Jamal is barking at Ezra: "Binder's on wrong, Miller—loosen the left side or you'll kill the vena cava!"
Ezra swears in Texan and fixes it.
River is holding the rapid infuser line with both hands because the nurse stepped away. Their arms shake.
Noah stands at the head, calm as death. "BP 40 over palp. We're pouring O-neg like it's happy hour."
Matteo's voice cuts through everything. "Cardiorrhaphy kit. He's got a right atrial tear. Asher—suture."
Asher's hands (steady despite everything) take the 3-0 Prolene. He and Matteo sew together while Leo keeps the aorta clamped and feels his fingers going numb.
Thirty seconds feel like thirty years.
Matteo ties the last knot. "Off clamp."
Leo releases. Blood surges back into the lower body. The heart fills, beats once (weak), twice (stronger).
Monitor: sinus tach, 140. BP climbing to 80 systolic.
Jamal whoops from the foot of the bed. "That's how you do it, Bellevue!"
For one heartbeat, the entire room breathes.
Then Matteo looks up (eyes finding each intern in turn).
Asher's hands are covered in blood up to the elbows.
River's scrubs are soaked from the infuser leaking.
Ezra is holding the pelvic binder like it's a football.
Leo still has one finger inside the aorta, just in case.
Matteo's voice is quiet, almost gentle.
"You four just saved a life. Together."
Asher meets Leo's eyes for the first time in days. Something cracks (anger, exhaustion, maybe forgiveness).
River starts laughing (high, hysterical, unstoppable).
Ezra drops to his knees right there in the trauma bay and says, "I think I just came."
Noah rolls his eyes so hard it's audible. "Get up, Miller. We're not done. He needs angio for the pelvic bleed."
But Jamal is already clapping all four of them on the back, huge hands leaving bloody prints on their white coats.
"Welcome to the club, interns. You're officially traumatized."
Matteo peels off his gloves, walks over to Leo. He doesn't touch him (too many eyes), but he leans in just enough to whisper:
"You did good, Leo."
Then louder, for the room: "All of you did."
The patient groans (alive, in pain, perfect).
Asher bumps Leo's shoulder as they wheel Mateo to the OR for definitive repair.
"Sorry I was a dick," he mutters.
Leo bumps back. "We all were."
River appears on Leo's other side, glucose gel smeared on their cheek like war paint. "Group hug later. When we're unconscious."
Ezra limps up behind them. "First round of cafeteria pizza is on me. After we sleep for three days."
Noah walks past, tossing over his shoulder: "You don't get to sleep. You get to write the op note. All four of you. Together. In one note. Make it poetic."
They groan in perfect unison.
But they're smiling.
For the first time since July 1st, they're a team.