em

she/her

[fxckingjo]

𝐂𝐫𝐚𝐬𝐡 𝐂𝐨𝐮𝐫𝐬𝐞 (𝟏𝟓)

ᴄʜᴀᴘᴛᴇʀ ꜰɪꜰᴛᴇᴇɴ ᴏꜰ ᴄʀᴀꜱʜ ᴄᴏᴜʀꜱᴇ. dbf!jack abbot/reader. age gap. explicit content. cw for the death of a parent, terminal illness, etc. 90% unedited. i'll revise one day. maybe.

Disclaimers and warnings for this chapter: First, this is all the result of brief research, and I am not a medical professional. All hospital policies and procedures and medical accuracy are not to be taken as gospel. I have an English degree and just love medical TV. Second, HEAVY warnings for child abuse, gun violence, etc. It is discussed on page, but does not occur on page. Discretion is advised, because it's a lot.

author's note: I'm so sorry Crash Course Friday is coming a bit late! I've been moving the last couple of days (why do I have so much stuff) (literally why) and I misplaced my computer for a bit. This chapter might be a bit raw but it was. so. much. fun. and so personal to me! I struggle a lot with overextending myself and working too hard, sooooo this was cathartic! Also spot the easter eggs and callbacks. I am quite proud.

p.s. there's smut in the next chapter. That's all I'm gonna say.

never miss an update by following @notify-fxckingjo and turning notifs on! updates every Friday at midnight PST!

and, most importantly, thank you for being here every week. what the fuck guys, i don't deserve y'all <3

⟲ last chapter // next chapter ⟳

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Your first night shift is where order goes to die.

You know the schedule for interns—two weeks on days, two weeks on nights, flip-flop in perpetuity. As for your R2 year, there might be more leniency, depending on where the attendings want you placed and how you work with the other residents as your responsibilities increase. The problem is your first night shift rotation happens to coincide with Shen's vacation, three nurses absent in what's shaping up to be a "sick out" strike, and two other residents calling out right before shift change.

Robby looks like he's been put through the meat grinder when you come on at seven, and Jack looks infinitely worse. 

The last week, you've been avoiding him outside of work, afraid to dissect your last conversation, which breaks every professional rule in the book. To be fair, you're also putting in backbreaking hours in the Pitt, and while Collins has praised you and Robby's given you two separate pats on the back, you're exhausted and drowning. Double boarding sounded like a good idea at the time you applied for residency, but now? You feel like you can't keep up.

When you're not at work, you're studying procedures and mapping out the human anatomy down to the nerves and minor blood vessels in the shower. Sleep evades you, your anxiety is taking up residence in your teeth, which you catch yourself grinding, and you eat out of takeout cartons over the sink when you remember to feed yourself. 

You know that, statistically, emergency physicians have the highest rate of burnout across the board. Still, after living your life as a gifted kid, a control freak, constantly driven by your need to excel, you hoped you'd be better off than this. Stronger, at least. 

Hubris. Pride cometh before the fall, or whatever the ancient proverbs say. 

"Alright, listen up, Nightcrawlers," Jack announces after you've all gathered at Central for handoffs. "We're down two nurses, two residents, and one attending. Mercy had a small explosion in their ER bathroom—"

"Explosion?" Santos interrupts. "Like a fucking bomb?"

Immediately, some of the nurses start chattering, the staff immediately on edge at the idea of a terrorist attack in Pittsburgh. Your pulse skyrockets. After COVID, the job of the healthcare professional has become more dangerous, and the political tensions alone are enough to make an urban emergency center feel more risky to work in. Being someone who reads too fast and too much, you're very good at catastrophizing, a thousand possible headlines playing rapid-fire in your mind's eye. 

Jack raises his voice, the picture of calm. "A patient on oxygen decided he wanted a cigarette and snuck one into the bathroom. No one was seriously hurt, but a pipe blew, and the ER was shut down for the next eight hours. All minor emergencies are being diverted to Presby, but we're the only major trauma center open right now."

Oh, fuck. This is bad. For a weekend, on a summer night following the holidays, where firework injuries are still coming through the Pitt at all hours of the night and day, you can only imagine what things will look like minus a hospital and a quarter of the staff already approaching skeleton crew status. 

Jack keeps talking. He's a hell of an actor, for a guy whose left hand is shaking ever so slightly. The tremble causes a glint where the light catches his wedding ring. "We can't afford unnecessary tests, because we don't have the staff. For the next two hours, our primary focus is going to be getting patients through the ER as efficiently as possible. Dr. Robby, bless his heart, has offered to stay—"

Robby pushes his reading glasses on top of his head, rubbing the back of his neck like the weight of his fifteen-hour day just doubled in size. "I'm the Chief of Emergency Medicine, brother, I didn't offer shit—"

"Let me talk you up, asshole," Jack interrupts. "Robby's gonna be here for more OT than is probably contractually allowed or obligated. Let's try not to need him too long. Santos, I want you with Ellis, med students in triage and sutures, Doctorpedia, you're with me, and if you get in over your head, call for a nurse first, then an attending. Fuck knows the nurses know more than I do half the fuckin' time anyway. We clear?"

The group gives a collective nod, and Jack is rushing off before you can get your bearings in the chaos. 

"What? No chant?" Ellis grumbles.

"There's a chant?" Trinity asks, following her to Curtain Six.

You jog until you catch up with Jack, who looks like a man on a mission.

"Where do you want me?" you ask.

"I'm giving you Fiat power," he answers. "See triage? Clear all non-emergent patients."

Rooted in the Latin phrase for 'let it be done', Fiat power is the authority to give unilateral executive orders. You remember the term from your political science classes. Hell, when you and Jack were at the museum, you told him about your interest in debate over a painting adapted from Plato's Symposium. 

Basically, Jack is about to let you write blank checks. If you're hearing this right, that is. "Shouldn't a more experienced resident handle that?" you stammer.

"I don't have any," he replies, passing you a tablet with a chart pulled up. "It's a Saturday night, and after ten, trauma cases spike. A lot of these guys are boarders, need stitches, which med students have handled, or they have no insurance and just need a doctor's note or a script for a runny nose. Write them." "Don't I have to clear that with an attending?"

"Hence the Fiat power," he quips. "Look, kid, I don't have time to explain my reasons to you, but I need Ellis in the curtain area, and Santos needs a senior resident. Robby and I agreed that, under the circumstances, you're our pinch hitter."

"Did you seriously just use a baseball reference?" "Are you the doctor I think you are or not?" Jack demands. "Look, we're working on finding extra hands down here, but in the meantime, I need your big, beautiful brain. If you get in over your head, I'm here. Got it?"

You nod.

"Go get 'em, baby," he says, and then he rushes off to an exam room before you can even register that he called you baby. 

The first hour is an assault on your senses. Triage is a barrage of screaming babies and bodily fluids, but everything Jack warned you about turns out to be correct. By hour two, you clear most of the patients, and Lena, the charge nurse on nights, checks in on you periodically. At one point, just when Robby's found a free moment, he listens to you summarize your last twenty patients with no notes, an unmistakable proud smile ghosting across his features. 

You're exhausted, in a way that gives new meaning to the word. When you were in college, you worked your ass off to graduate early and pull forty-hour weeks at your awful minimum wage job. In med school, you functioned on no sleep all the time, because that was what it took to perform at the highest level and finish top of your class. You thought you knew what it meant to be tired, what it meant to exhaust yourself. 

You were sorely mistaken.

Trinity hasn't been shy about complaining about her stress, and the two of you have been sharing meals and laundry responsibilities to keep your heads above the water. Most of the time, you just listen to what she has to say, offer sympathy, and make her an extra shot of espresso in the morning. 

To her, to the whole Pitt, you're Doctorpedia. You translate when she needs it, act as a soundboard for differentials, answer questions during rounds, and get called into traumas all the time. She's more happy for you than jealous, but you know she expects you to be together, to keep acing the tests and telling her about all your saves and cases. The senior residents let you figure things out on your own most of the time, and Robby treats you like his golden goose, always there for a challenge.

You've started losing your hair, and the bags under your eyes are growing more pronounced every day. You don't know how you're going to keep going like this without cracking under the pressure, and whenever Ashleigh or your dad calls, you lie through your teeth because you're their genius daughter, the one they don't have to worry about.

The Sistine Chapel is full of cracks, but you can only see them if you're looking too closely.

But you don't have time to fall apart. So you don't.

Once you've cleared enough patients from chairs and Robby's signed out for the night, you take it upon yourself to restock some of the supply carts, which is mostly a med student's job, but you need the monotony. You knock back a Monster from the vending machine, your eyes bleary as you squint at the board. It's still a mess, full of patients and codes, but it's better than it was at the start of your shift.

It's a quarter to eleven when all hell breaks loose.

First, a psych patient gets loose from his soft restraints and runs around naked and pissing all over the floor, being dosed with Haldol and restrained to the gurney by every limb. Then, a motorcyclist without a helmet gets brought in DOA, occupying a bed in Trauma for organ donation. You administer two doses of Narcan, one to a college student roofied at a party, another to a homeless man found in the park across the street. The junkie is the one who makes it, and asks if you kept his needle when he comes to. You can hear the scream of the girl's mother all the way across the ER when Jack tells her her daughter was unable to be resuscitated. 

This is the flow of the Pitt. You've come to expect it, in the time you've been here. You know the pace, how many patients come in and what their chief complaints are. You never judge anyone who walks through the doors, even if they're uninterested in help from social services or spit in your face. That doesn't mean you don't care for every patient, mostly because your memory means you don't really have another choice. 

You're charting at Central when Lena makes the announcement. "Abbot, we have three traumas coming in. Two kids, one adult. One stable, two critical. Adult GSW to the head, one possible TBI with skull fracture, and another kid with several broken bones and possible pulmonary contusions."

"How far out?" Jack asks.

"Three minutes."

"Fuck," he groans. "Okay, page surgery, now, get neuro down here, I need the organ donor out of Trauma One, put him in peds and keep him monitored. Prep the trauma rooms with pediatric equipment, chest tube trays, the works. Ellis, Santos, I need you in Two; you're meeting surgery, and if they aren't here in five minutes, Santos, you will drag them here yourself, understand?"

Trinity nods, a bit stunned. 

Jack calls your name next, and you're relieved he didn't call you Doctorpedia. Not right now, when you're barely holding your own and feeling anything but brilliant. "I want you close. Once we see how stable the kid is, I need you to watch him while I handle the others. Could turn at any second. Clear?"

"Yes," you say.

The ambulance bay doors burst open, and three gurneys wheel in simultaneously. The first is a man whose head has been blown open, half of his face shredded, skull fragments and gray matter being held together by bandages and a prayer. The medic is bagging him, but the monitor is asystolic. The guy is dead as a doornail, but what catches your attention are his knuckles, bruised and split.

It doesn't take a genius to put the pieces together as his sons come in behind him.

The paramedic carting the father briefs Jack first. "Marcus Jakobs, forty-six, BAC of .27, lost his pulse en route, down time of approximately thirty minutes, no spontaneous resps, asystole on the monitor."

"This man is a cadaver," Jack snaps. "Call it. Time of death, 23:18. Cover him, call the morgue." 

A little boy, no older than five, lies still on the next gurney. They're bagging him, but his eyes are closed, one side of his face swollen shut, his jaw busted, a handprint burned into his throat. He is, "Andrew Jakobs, five years old, unconscious on the scene, BP is crashing—"

"Trauma Two!" Jack whistles at Trinity and Ellis, who spring into action as they transfer little Andrew to the bed and start buzzing around him, grabbing supplies, working hard to stabilize him.

The last patient is an older boy, seven, named Tommy, who's cradling a broken arm, crying. "Andy wouldn't stop crying. He gets so mad when we cry. It's over faster if we don't cry—"

"Tommy," you say gently. "I need you to lie back, sweetie. We're gonna take good care of your brother, I promise."

Tommy's face is splattered with blood. You don't think most of it is his. "I didn't mean to kill him, but he wouldn't stop—" 

Oh, Jesus Christ. Tommy's shoulder is dislocated, and his collarbone definitely fractured, because he shot his own father. High-caliber GSW, probably a sawed-off shotgun with an extra kick to it. His pulse on the monitor is wild, and he's hyperventilating beneath the mask.

Jack is giving orders to the nurses, but you're standing still, Tommy's tiny hand squeezing yours as hard as he can, desperation painting his face as it contorts in fear and agony. All you can do is wear a mask, talking him down, starting your differential diagnosis.

"Abbot, he's coding!" Ellis screams from Trauma Two.

"Keep him calm, keep him talking," Jack orders before he leaves you in Trauma One with Tommy.

"I want to see Andy!" Tommy wails.

"I promise you, you will see your brother very soon, but we have to make sure he's okay first, Tommy," you assure him, trying to keep your voice calm, soothing. "Tell me where it hurts, okay?"

You start your exam, running through every step in your mind as you push the morphine. He's probably a candidate for an exploratory laparotomy, because the tenderness in his belly suggests internal bleeding, not to mention the trauma to his chest. You have no idea how he's still conscious, given what you're seeing. He's a tough kid running on adrenaline, for sure.

"Did your dad hit you first?" you ask. "Where?"

"My back, and my tummy." He sniffles. "He hit Andy more."

"I want you to hear me," you say softly. "No one is ever going to hurt you again, okay? You're safe. You don't need to protect Andy, okay? Understand? We've got him. I'm gonna give you something for the pain, and we're gonna take some X-Rays, alright? I need you to stay still, to make sure you don't shift any broken bones."

Just one look at his torso, at the purple and black bruises and the healed yellow-brown tones of old ones, he's probably got some broken ribs. If you can get him calmer, you can discern between what is pulmonary trauma and what is the result of anxiety. You can't give him too much pain medication, or his resps will crash, and this is really not a situation you should be taking point on. 

Tommy whimpers. "I don't want to go to hell."

You gently squeeze his hand. "You won't go to hell, Tommy. You saved your brother, you hear me? You're a hero. Who's your favorite superhero, hm?"

"Superman," he answers.

"He's a great superhero," you say.

"He's brave."

"But you're braver, you know why?"

Tommy shakes his head. 

"Superman isn't brave, he's indestructible. He knows if he punches the asteroid, he's gonna be okay. But you? You did a brave, brave thing even though you were hurt too." You push some of his hair out of his eyes, guiding him through a focal neuro exam. "That's so much braver than Superman, buddy."

He nods, sniffling. A monitor starts beeping, and his gaze gets a bit hazy, like he's fading fast. 

"Sats are dropping," one of the nurses shouts. 

"Hey, Tommy?" You rub his sternum as his eyes slip closed. "Tommy!"

"He's crashing!"

And across the hall, so is Andy. You can't get a good view from where you're standing, but you get the gist. It's not looking good, and you're alone.

"Where the hell is surgery? I need another doctor!"

"Surgery's been paged," someone says.

"You!" You snap your fingers at a med student. "Run. Do not walk, RUN! Get me a trauma surgeon, now!"

Your hands are trembling. The world is tilting off its axis. Everything is narrowing to this moment, to the tiny body on the gurney in front of you and the room full of people all asking you what to do next. 

Tommy is going to die, unless you doctor the fuck up.

"I need an intubation tray. Give me cricoid pressure," you bark, angling the scope. "Dammit, there's swelling. The cords are…"

One of the nurses, Vivi, chimes in, "Do we need to crike him? I can get the kit."

"Not yet," you decide. "More pressure. There. I'm in. Bag him!"

There's a moment where his O2 sats are climbing again, but it falls once more. You breathe in and out, tuning out the rest of the world as you listen to his chest. The heart sounds are muffled, and you don't have time for an ultrasound.

All you have are your statistics.  

"Tension pneumothorax," you realize. "Get me a chest tube tray. Now! His lung's collapsed!"

You look over at the other trauma room, where Jack is dripping sweat over Andy's body, and the whole team looks like they've come to the conclusion the kid is too far gone. You don't believe in a god, and practicing medicine won't make you start now, but you believe in Jack, who's a great doctor, and you believe that there has to be some fairness in the world that wouldn't mean Andy dies, and his brother committed patricide for nothing. 

You can't lose Tommy either. Not like this. Not when he thinks he's going to hell for trying to save his baby brother. But your hands are shaking, and everything is too loud, too much, all at once, and you don't know if you can handle this, because if you're not careful, you could cut into him for nothing and—

Breathe, you tell yourself.

"Where is surgery?" you ask again.

"I don't know," one of the nurses says, "but you're all he has."

And so you plunge the needle into his chest, and the air rushes out as his lung reinflates. His oxygen levels climb, and his heart stabilizes, with the bilateral sounds of his breathing dramatically improved for both you and the nursing staff. Just as you're stepping back from the table, the surgeons arrive, your med student breathless beside Yolanda Garcia, who looks both horrified and impressed.

"Took you long enough," you croak.

She raises her eyebrows. "Jesus fucking Christ."

The next ten minutes are a blur. Tommy and a now stable Andy are both taken upstairs to surgery, and you're faintly aware of the nurses congratulating you, Ellis giving Trinity notes as they debrief, the Pitt continuing to move at a thousand miles an hour around you. The white noise in your head builds to a crescendo—almost a scream. A phone is ringing, monitors are beeping, a patient is shouting for a nurse, and you feel like you've plunged to the bottom of the ocean. Everything is happening around you at a distance, like you're slipping further and further into the abyss. 

"I need some air," you manage to say, to no one in particular, before stumbling into the ambulance bay.

You collapse onto the sidewalk, and then, when you're blessedly, completely alone, you finally let yourself shatter.

You've never been very good at feeling your feelings. For most of your childhood, you regulated your mom and worried about the bills and keeping everything paid up on time, since you had the penchant for numbers. You achieved excellence until it was expected of you, and you rose to the challenge. Whenever you had a difficult feeling, you'd dissect it and take it apart like an autopsy of the soul until it was so intellectualized to death you were detached. 

You never cried much, never admitted defeat. How could you? Someone had to hold the world up, and you refused to shrug the Atlas.

It wasn't until your mom died that you truly learned what it felt like to grieve, and you cried oceans in your sorrow. After Jack and that fateful summer, you cried some more, let yourself feel twenty years of bottled-up emotions, and then packed it all away when you left for Columbia. You've kept it together, played it cool, performed and danced and ticked like a perfect machine.

But now? Now, you fucking sob. 

You don't know how long you sit there, stethoscope clutched in your shaky, sweaty hands, tears pouring down your cheeks and snot bubbling under your nose. You cry until your ribs hurt, until your body is so tired of weeping it gives only empty hiccups instead of sounds. The panic crashes over you like a wave, and you're caught in the rip current of anxiety, struggling to get out.

Then you hear your name coming from far away.

Then louder.

And then up close.

Hands close around your cheeks, cradling you. Jack's hazel eyes swim into view. "Hey, sweetheart, look at me. Look at me. I'm right here. I need you to breathe. Can you do that for me, baby? Can you breathe?"

He's out of breath, and you realize he must've sprinted out here to get to you the second he noticed you were gone. His leg's been bothering him all shift; you've watched him lean onto his good side, gripping his thigh when he thought no one was paying attention, and still. 

Still. 

He ran to you.

"Come on, breathe with me," he urges you, putting your hand on his chest as he inhales for an exaggerated length of time. "In. Hold it. Yeah. There you go. Out. One more time. That's it, baby. Doing so good for me. In. Out. That's it. One more time. You got it. Uh-huh. In…"

He coaches you through it with that patient, tender tone of his you've only heard him use when talking to you. Like he melts, and all his hard edges dissolve into softness just to meet yours. 

When you finally calm down, he dries your tears with his sleeve, wiping your nose with gauze pads and a light chuckle. 

"I'm an ugly crier," you whisper, voice hoarse.

"Nah," he corrects you, "you're still beautiful. Even covered in snot."

"Sorry."

"Don't be sorry. Talk to me."

"He almost died," you tell him. "Jack—"

"I heard he crashed, and you intubated him, diagnosed and repaired a tension pneumo, and got him to the OR stable," he replies, patient but firm. "I also heard you kept him calm, comforted him, and handled a solo trauma better than most R3s would have. As a first year. You're brilliant."

"I never should've been in there alone," you argue. "This whole day, I've been… I'm just an intern. And everyone wants me to be the brilliant Doctorpedia, handling everything, and I'm still learning and I can't fucking do it—"

"Hey," he cuts you off. "Slow down, sweetheart, you'll work yourself up. I know. And I promise you, Robby and I are gonna make sure this doesn't happen again. The staffing issues are unacceptable, and if it were any other intern, today would've been full of bad outcomes. That doesn't mean we should expect that of you, okay?" He gazes into your eyes harder, imploring, like he needs you to see him. Hear him. 

You nod. "Okay."

"Today was a one in a million," he assures you. "But I am so fucking sorry I put that kind of pressure on you."

"I can handle it."

"You shouldn't have to," he insists. "You're already extraordinary, even without giving everything you have and then some. And if this is you as a fucking intern, sweetheart, I'm already in awe of the doctor you'll be by the time you're an attending."

You nod. Everything inside of you feels massive and important and messy, and all you've got are abstractions and vague feelings you can't put into words. All you can focus on is him, and he becomes the fixed point you use to ground yourself in freefall. He's your parachute when you feel like you'll never stop falling.

"I'll make sure we give you time to get there," he continues. "But as your attending, I'm here to teach you, yeah?"

You nod again.

He hugs you tightly, and you fist his scrub top tightly in your fists, still shaking. His breath fans across the top of your head as he kisses your forehead. "Hell, baby, I'm pretty sure you're teaching me a lot more," he murmurs. His lips find your temple next, his face barely pressing into your hair like he's breathing you in.

You half expect him to let go, worried someone might walk out and see this, but he doesn't. You greedily indulge yourself, soaking in the moment, terrified that in the next one, he'll be distant again, and you won't have Jack to anchor you. Once you go back inside, it's over, and you go back to pretending this is strictly professional.

But under the night sky just before midnight? He's your Jack a little longer. 

"You gotta say 'when', by the way," he whispers in your ear. "'Cause when a pretty girl is crying in my chest, I ain't letting go first."

An ambulance siren howls in the distance, gradually getting closer and reminding you of where you are and the job you have to do. So, you give him one final squeeze and whisper back, "When."

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