Coffee & Case Notes

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[pflh1024]

AFFECT EFFECTS

02. Margin of Error

pairing: jack abbot x reader rating: mature (18+) word count: 5.1k

warnings: medical themes • trauma cases • grief • references to parental illness and death • trauma response/dissociation • emotional distress • slow burn

summary: a trauma activation pulls you back to a memory you thought you had buried. After a difficult shift and an even harder conversation with Dr. Abbot, the hospital roof becomes the last place either of you expected to have an honest conversation.

a/n: well… based on your comments on the last post, here is Part 2! 🫶

this story actually began as an OC fic on Wattpad/AO3! I've always loved reader inserts, but Wattpad always felt easier with an OC. That said, I love being able to put myself in the story a little too much, so turning this into a reader insert just felt right.

thank you for all the support on the first chapter. I hope you enjoy this one! 🤍

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Morning in the emergency department feels different than nights.

The pace isn't necessarily faster, just different. Families fill the waiting room, consults stack up faster than anyone can answer them, and the phones ring often enough to become part of the background noise. Night shift wears its exhaustion openly. Day shift hides it beneath constant movement.

You're halfway to the board before anyone notices you've arrived. The department is already in full motion around you—conversations overlapping at the nurses' station, someone calling out orders from down the hall, a monitor alarming somewhere in the background while another phone starts ringing.

You sign in quickly and scan the board. Your eyes move automatically across room numbers, updated notes, pending labs, and names changing before you've fully finished reading them. Most of it looks manageable. Enough of it doesn't.

The kind of board that doesn't give you much time to ease into the shift.

Your name pulls your attention away from the screen.

You look up just as Dr. Whitaker steps toward you with a chart already in hand, looking like he's been searching for you.

"Room nine," he says. "Twenty-six-year-old female. Abdominal pain since yesterday. Vitals are stable, labs aren't showing much. I gave Toradol, which helped a little. I was thinking imaging if it doesn't improve."

You take the chart from him, scanning the note as he talks. "Pain localized?"

"Lower abdomen. Mostly right-sided."

You nod once. "Okay. I'll take it."

Before you can step away, Victoria glances up from a notebook that's still somehow color-coded and perfectly organized despite the end of a shift. "She said it gets worse after eating," she adds. "And she's had similar pain before. Just not this bad."

You slow just long enough to nod. "Good to know."

Victoria gives a small nod of her own and goes back to her notes while, to your left, Dr. Santos leans against the counter with her arms crossed, watching the board like she's already anticipating the next problem.

"You're inheriting a decent spread," she says. "Could be worse."

You flip through the chart again. "It will be."

That earns a small smile. "Yeah," she says. "Probably."

Across the station, Samira finishes handing off another patient before passing the chart across the counter. "Vitals have held, but the trend's not obvious. I'd keep an eye on it."

"I will," you say, nodding once.

She studies you for another second, then offers a small, almost absent smile before turning back toward the board.

Dana is already moving through the department, checking in with nurses near triage, adjusting assignments on the board, and stepping in to address small problems before they have a chance to turn into bigger ones. The overlap between shifts is almost over, and she's making sure nothing gets left behind.

She passes you near the workstation without stopping, her eyes flicking over you briefly as she goes.

By the time the last of sign-out wraps up, the department has settled into a different rhythm. The overlapping conversations have faded, the phones have quieted, and the controlled chaos of shift change has finally given way to the work itself.

At the desk, Robby is finishing the last of his notes when Jack steps in beside him. Neither of them seems in any hurry. They exchange a few quiet words, falling into an easy rhythm that makes it obvious they've done this together hundreds of times before.

"How's she doing?" Robby asks, glancing toward the board.

Jack doesn't look up from the chart in front of him. "She's good."

Robby looks at him for another second. "That's all I've got?"

That finally earns him a glance from Jack. "She knows what she's doing."

The corner of Robby's mouth twitches. "Try to play nice."

Jack's attention has already returned to the chart, which earns another quiet laugh before Robby pushes away from the desk and heads back into the department.

A few feet away, you're already heading toward your next room. You don't catch the words themselves, only the sound of voices somewhere behind you. By the time you glance back toward the desk, Robby is gone, and Dr. Abbot is already looking at the board again.

You forget about it almost immediately.

You're halfway through updating a chart when Lena calls across the station.

"Room six is yours."

"Got it," you say, already pushing away from the computer and heading down the hall. 

The patient is young, in her early twenties at most, curled slightly on the bed with one arm wrapped around her abdomen. She looks exhausted, like she's been dealing with the pain for longer than she wants to admit.

You pull on a pair of gloves as you step into the room, letting the door swing partially shut behind you.

"Hi," you say, stopping beside the bed. "I'm one of the doctors down here. Tell me what's going on."

"Stomach pain," she says immediately, her voice tight with exhaustion. "Since this morning. It just keeps getting worse."

"Where?" you ask, and she hesitates before moving her hand lower, toward the right side of her abdomen.

You keep going through the rest of the questions—nausea, vomiting, fever, appetite, when the pain started—letting the answers fill in the picture as you piece it together.

When you press on the right lower quadrant, the reaction is immediate. She flinches, her breath catching before she can stop it. You already have a pretty good idea of where this is headed.

"Alright," you say, pulling off your gloves as you step back from the bed. "I'm going to order some labs and get some imaging, okay? I just want to figure out exactly what's going on."

She nods quickly, looking relieved to finally have a plan.

You turn toward the door and nearly stop.

Dr. Abbot is standing just outside the room, slightly off to the side, his attention fixed on you in a way that makes you think he's been there longer than you realized.

"What are you thinking?" he asks.

The question is simple enough, but it still feels like being put on the spot.

"Appendicitis is highest on my differential. Pain started diffuse and localized to the right lower quadrant. Nausea, possible fever. Labs are pending, and I want a CT. If it's confirmed, I'd call surgery."

His gaze stays on you for another second before he asks, "What else?"

For half a second, you run through the differential again in your head, looking for the thing you might have missed.

"Could be ovarian. Less likely renal or GI based on how it progressed, but appendicitis fits best right now. I wouldn't wait too long on imaging."

His gaze flicks toward the patient before settling on you again. "CT ordered?"

"It's pending."

He nods once. "Alright."

The response tells you absolutely nothing. No correction, no approval, nothing to suggest whether your answer was enough or whether he's still turning it over in his head. Then he steps into the room, taking in the monitor, the orders, and the rest of the setup without saying a word.

You find yourself looking away first, turning back to the computer to finalize the imaging order and update the chart before you can think about it any longer. When you glance up again, he's already finished his silent assessment of the room and is stepping back into the hallway.

You don't follow right away. Instead, you take one last look at the patient, answer a few questions, and make sure she's at least comfortable enough to wait for imaging before stepping back into the department.

The noise meets you almost immediately.

Ellis is leaning against the counter outside the room with one glove still half-peeled off her hand, like she'd gotten distracted halfway through taking it off. She glances up as you approach.

"He do that thing where he just stands there and doesn't say anything?"

You pause. "What thing?"

She gives you a look. "That thing. Where you're explaining your differential and he's staring at you like you missed something obvious."

As she says it, she somehow manages to mimic the expression almost perfectly—blank enough to be mildly concerning.

A laugh slips out before you can stop it. "Yeah."

"Then you're probably fine," Ellis says, finally pulling off the other glove. "If he doesn't correct you, it's usually because there's nothing to correct."

Shen passes behind the two of you a second later, taking another sip of his iced Dunkin coffee as he glances between you.

"You talking about Abbot?"

"Always," Ellis answers immediately.

Shen takes another sip before looking at you. "If he's quiet, you're good. If he starts asking questions, then you should worry."

You glance back toward room six before looking at the board again. "That's a deeply unhelpful system."

"It's actually very helpful," Shen says easily. "You just don't like it."

Ellis snorts and pushes herself off the counter. "Room eight's yours, by the way."

"Of course it is," you mutter.

Room eight is older, confused, and medically complicated in the exhausting way that requires pulling information apart piece by piece just to figure out what actually matters. Nothing is straightforward. Every answer seems to lead somewhere different from what you expect, and by the time you finally untangle one issue, you've found two more.

You work through it anyway, patient as ever, taking it one step at a time. By the time you finally step back into the hallway, you've spent far longer in there than you meant to.

Lena is back at the desk, reorganizing the board as you walk up. Her eyes flick briefly toward you. "Six is covered?"

"CT's pending," you say. "Everything else is in."

"Good."

And just like that, her attention is somewhere else.

Around you, the department keeps moving. A paramedic wheels an empty stretcher past the station while someone calls for respiratory down the hall. Phones ring. A printer spits out labels no one's picked up yet, and somewhere behind you, Shen is trying to convince radiology to read a scan faster.

You take one last look around the department before heading for the next room.

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The department has settled into a steady rhythm by the time the overhead cuts through the noise.

"Trauma incoming. Multi-vehicle collision. Multiple patients. ETA two minutes."

The change is immediate.

Conversations end mid-sentence. People turn instinctively toward the trauma bays, half-finished tasks abandoned without a second thought as everyone shifts into place. There isn't any panic to it. If anything, the department gets quieter.

You turn with everyone else, pulling on gloves as you head toward the bay. Ellis falls into step beside you, tying the back of her gown without breaking stride, while Shen finally sets his iced coffee down on the counter. Across the room, Lena is already assigning roles, and by the time you reach the trauma bay, you're exactly where you're supposed to be.

The doors burst open seconds later.

The first patient comes in fast, blood matted through his hair, and one leg twisted at an angle that immediately suggests a severe fracture. Another stretcher follows close behind, carrying a second patient who looks more stable, though not by much. Information starts coming all at once—mechanism, vitals, visible injuries—pieces of the scene arriving faster than anyone can put them together.

You automatically move toward the second stretcher, hands already reaching for gloves as you start your assessment.

"BP?"

"Stable."

"Let's get another line in—"

You pull the hospital gown back slightly to check for additional injuries, and that's when you see it: bruising across the ribs, already darkening beneath the skin. Your hand pauses, and for a second it isn't the patient in front of you.

It's your mom.

Fluorescent lights. The sharp smell of antiseptic. Your mother lying too still in a hospital bed, bruises spread across pale skin, while you stood beside her pretending not to notice how much smaller she looked.

You take a step back before you realize you're doing it, not far, just enough to lose your place. Around you, the trauma bay keeps moving. Ellis is still working beside the stretcher, Shen is saying something from across the room, and Dr. Abbot's voice cuts through from somewhere to your left, calm and steady as he keeps everything moving.

Everything except you.

You don't look up immediately, but you know he's closer now. You can feel his attention settle on you before he asks, "What are you doing?"

The question cuts straight through the haze and pulls you back into the room.

You blink, and suddenly the trauma bay is there again—the patient on the stretcher, the monitor alarms, Ellis working beside you, the place in the assessment where you'd stopped.

"I've got it," you say quickly, already stepping forward again. You reach for the patient's arm, picking up where you left off and forcing yourself back into the rhythm of the room.

For a second, Dr. Abbot watches you instead of the patient. Not confused, but not entirely convinced, either, as though he's trying to decide whether you actually have the situation back under control or if he needs to pull you from the room.

Whatever he sees seems to make him pause.

The look on your face a second ago hadn't been hesitation. It had been something else entirely—farther away than that, briefly disconnected from the room in a way that doesn't belong in the middle of a trauma.

And he knows that look.

Not the reason for it. Not the specifics. Just the look itself.

He's seen it before—on soldiers overseas, on residents after bad codes, and in mirrors he stopped looking at too closely years ago. That split second where someone leaves the room before they realize they've done it.

His jaw tightens, whatever he'd originally been about to say shifting course before it reaches his voice.

"If your focus is somewhere else, you're no use to me here."

Your jaw tightens. "I said I've got it," you say, the words coming out flatter than you intend.

Dr. Abbot watches you for another second instead of the patient, his expression unreadable, as though he's deciding whether to push the issue. Then he gives a short nod and turns his attention back to the stretcher.

"Then stay with it."

The words are matter-of-fact, leaving no room for what just happened.

You let out a quiet breath through your nose and force yourself back into the assessment. "Let's get another line," you say, glancing toward the monitor. "Repeat vitals in five."

The nurse moves immediately. Across the room, Ellis is already calling for imaging while Shen adjusts fluids near the head of the bed, another monitor alarming before someone reaches over to silence it. The trauma bay doesn't pause for moments like this, and neither do you.

By the time Dr. Abbot glances back in your direction, you're already working through the assessment again, and this time you don't lose your place.

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By the time the shift ends, it doesn't really feel like it has. One minute you're finishing your last note, and the next, day shift is filtering back into the department, picking up conversations and patients as though the last twelve hours never happened at all.

You don't wait around to watch it happen.

You sign out quickly and head for the hallway, barely paying attention to who's still at the desk. The fluorescent lights feel too bright now, the noise of the department suddenly grating in a way it hadn't been an hour ago. You keep walking, only starting to slow once you've made it past the trauma bays and the sounds of the ER begin to fade behind you.

Your name carries down the hallway behind you, and you already know who's calling before you turn around.

Dr. Abbot is already walking toward you, stethoscope still hanging around his neck. He stops a few feet away—not close enough to block your path, but close enough to make it obvious this isn't a passing conversation.

For a moment, neither of you says anything. Then he says, "You stepped out of the room today."

It's not phrased like a question, and before you can stop yourself, your arms fold across your chest. "I handled it."

"That's not what I said."

Something shifts in your expression after that, small enough that you might not have noticed it yourself, but he does.

"If you need a minute," he says evenly, "you take it before you walk into a trauma bay. Not in the middle of one."

The correction hits differently out here, without monitor alarms and people moving around you.

Your jaw tightens. "It won't happen again."

"That's not the point either."

His voice never rises. If anything, it only makes the conversation feel more inescapable.

"You don't get to disappear in the middle of an assessment because something caught you off guard," he continues. "Not with patients depending on you to stay in the room."

You feel the irritation immediately. "I said I handled it."

"You recovered," he corrects. "There's a difference."

For a moment, neither of you says anything. The hallway suddenly feels too quiet, the hum of the fluorescent lights and the distant rhythm of monitors carrying from somewhere deeper in the department.

Dr. Abbot studies you for another second, his expression giving nothing away.

"If your focus is compromised," he says finally, "I need to know before you're standing in my trauma bay."

Not the trauma bay. My trauma bay. There's something strangely possessive about it, and the thought stays with you for a second longer than it should.

You straighten slightly despite the exhaustion dragging at your shoulders. "My focus isn't compromised."

Dr. Abbot studies you for another second, his expression giving nothing away, and you can't tell whether he's evaluating the answer or deciding how much further to push the conversation.

Eventually, he nods.

"Good. Because if it happens again, you step out before I have to tell you to."

The warning hangs between you for a moment before he moves past you without another word, already turning back toward the department like the conversation ended the second he decided it had.

You stay where you are, jaw tight, your pulse still refusing to settle. Part of you wants to be angry with him for calling you out in the middle of a trauma, then stopping you in the hallway afterward like the conversation wasn't over. For speaking to you like you'd become a liability the second you lost your footing.

Mostly, though, you're irritated because he noticed.

A few seconds pass before you start moving again. You push through the heavy metal door at the end of the hall and start up the stairs. With each landing, the sounds of the ER grow fainter until there's nothing left but the sound of your shoes against the concrete.

You don't think about where you're going until you reach the roof access door.

The handle is cold beneath your hand as you push it open and step outside. The air catches you off guard, sharp enough to clear your head for a moment, and you stop there, looking out over the city. Beyond the edge of the hospital, Pittsburgh is just starting to wake up.

A railing sits several feet back from the edge, and you find yourself walking toward it without really thinking about it. You lower yourself onto the concrete, the cold immediately seeping through your scrub pants, but you don't bother moving. Instead, you pull your knees closer to your chest and rest your forearms across them, listening to the wind sweep across the rooftop and the faint hum of traffic somewhere below.

For a little while, the cold helps.

Then it doesn't.

The memories come back the way they always do—pieces instead of full scenes. A phone ringing, someone speaking too carefully, and then the feeling of knowing something was wrong before anyone had actually said it. Your father's name. The word accident. Then another word you don't remember hearing, so much as feeling.

You remember sitting there afterward, waiting for the world to stop.

It never did.

That's the part you remember most. Not the phone call itself, but the way everything kept moving afterward. People went back to work, bills still had to be paid, and the sun still came up the next morning.

And somehow, you were expected to keep moving too.

The funeral comes back next in uneven pieces. A room full of people speaking too softly, offering condolences as though the right combination of words might somehow make any of it easier. You remember standing there in black clothes that suddenly felt too tight, nodding when people spoke because it seemed easier than saying anything at all.

More than anything, you remember the empty space beside you.

Your mom should have been there. She should have been standing next to you through the quiet conversations and unbearable stillness of it all instead of lying in another hospital room while doctors spoke in careful, measured voices and everyone around you kept saying she was stable.

As if that word meant anything anymore.

Your grip tightens around your arms as the memory shifts again, carrying you somewhere else entirely—the drive home afterward, the front door unlocking beneath unsteady hands, and the strange, immediate realization that home didn't feel like home anymore.

You lower your forehead to your knees and close your eyes, trying to push the memories back into the place you usually keep them.

Tonight, they won't go.

The grief stays exactly where it is, heavy and unmoving beneath your ribs.

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By the time Jack makes it back to the desk, the morning has fully taken over the department. Day shift is in motion, nurses moving between rooms, charts changing hands, and the overnight fatigue has settled into everyone in that particular way that comes right before people finally go home.

Robby is still at the workstation finishing the last of his handoff notes when Jack stops beside him. For a minute, they focus on the remaining trauma patient instead.

"CT confirmed splenic involvement," Jack says, eyes still on the chart in front of him. "They've already got him upstairs."

"Alright." Robby finishes typing, then leans back in his chair and gives Jack a look. "You wanna tell me what that was about?"

Jack's attention never leaves the screen. "What?"

Robby gives him a look. "Don't do that. You know exactly what."

Jack exhales through his nose, already sounding tired of the conversation. "She stepped out in the middle of a trauma."

"For half a second."

"That's all it takes."

"Yeah," Robby says, "and you still tore into her in the hallway like she killed somebody."

Jack's jaw shifts slightly. "I corrected her."

"Bullshit."

Robby watches him for another second before speaking again. "You've had residents freeze before. You don't usually corner them after shift change unless they actually endangered somebody."

Jack doesn't answer right away. The silence stretches long enough that Robby takes it as one anyway, and with a quiet sigh, he pushes his chair back from the desk.

"She's a good resident, Jack."

"I know." The answer comes immediately.

Robby studies him for another second. "Then why are you treating this like she just tanked her career?"

A beat passes before Jack says, "You didn't see her face in there."

"No," Robby says, reaching for his coffee. "I saw yours afterward."

A second later, he stands and grabs the cup from beside the keyboard. "Just… don't make her think she can't recover from one bad moment. That's not how you teach people to work trauma."

Jack doesn't answer.

Robby waits another beat, then heads back into the department. Once he's out of sight, Jack's attention drifts toward the now-empty hallway before dropping back to the chart in front of him.

A full thirty seconds pass before he realizes he hasn't read a single word.

Around him, the morning carries on—phones ringing, nurses trading updates, someone laughing somewhere down the hall. Most days, that's enough to drag his attention back to the job.

This morning, it isn't.

He exhales through his nose, pushes back from the desk, and heads for the stairwell.

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The door behind you opens with a soft metallic click.

You don't look up right away. You just listen to the footsteps crossing the roof—steady, unhurried—and by the time the voice comes, you already know who it is.

"You're farther back than Robby usually sits."

You lift your head. Dr. Abbot stands a few feet away with his hands in the pockets of his scrub pants, the light from the stairwell catching the tiredness in his face before the door swings shut behind him.

"Guess that means the night could've gone worse."

Your gaze flicks briefly to the railing beside you before returning to him. "Good to know."

For a moment, neither of you says anything. He looks out over the city instead, the first light of morning settling over the buildings below, and you find yourself looking away again, your arms tightening slightly around your knees. Whatever's sitting in your chest is still there. It's just easier to ignore.

Beside you, he lets out a slow breath. "Long night."

A tired breath slips out through your nose, close enough to a laugh that it surprises even you.

"Something like that."

You expect him to head back downstairs, but he stays where he is beside the railing for another moment before asking, "You gonna tell me what pulled you out of the room?"

You don't answer right away. The wind cuts across the rooftop hard enough to sting your face, and you watch your breath disappear into the cold air before finally saying, "Not quite yet."

Abbot studies you for another moment, then gives a small nod. "Alright."

The quiet that follows feels easier than the one downstairs. Eventually, you rest your chin against your knees and keep your eyes on the city. "It wasn't the patient."

"I figured," he says.

You glance at him at that. Something about the certainty of the answer catches your attention, but he's still looking out over the city, as though he never needed the explanation in the first place.

"Then why ask?"

Abbot exhales slowly. "Because it pulled you out of the room."

You look down for a moment, your grip tightening slightly around your arms. "For a second."

"That's all it takes," he says evenly, and then, after a beat, "Doesn't mean you didn't recover."

You let out a slow breath. "I'm not in the habit of stepping out."

"I didn't think you were."

Your gaze drops to the concrete for a moment before you look back out at the city. "Good," you say, and this time it almost sounds like a joke.

Abbot looks at you for a moment, like he's reassessing something, before saying, "You corrected it before it compromised patient care."

The words settle between you. You stay quiet for a moment, your gaze fixed somewhere over the slowly brightening city.

"Yeah," you say finally, your voice softer this time.

The rooftop falls quiet again, the wind moving across the concrete while the sounds of the hospital stay muffled behind the stairwell door. After a while, you shift against the railing, stretching your legs enough to ease some of the stiffness from them.

"You come up here after every shift?"

"Most," he says.

You glance over at him. "Why?"

One of his shoulders lifts slightly. "Quieter."

You nod, like you already knew the answer before you asked.

The sky is brighter now, the first real light of morning settling over the city. When you glance over, he's still watching you, but the sharpness from earlier is gone. He doesn't look like he's waiting for an explanation anymore.

For some reason, that makes it easier.

"It was a car accident."

Abbot goes still beside you. After a moment, he asks quietly, "That what it was?"

You nod, your gaze dropping back to the concrete. "Someone else caused it." The words catch briefly in your throat. "My dad died."

It still doesn't feel any easier to say, and you have to swallow once before adding, softer this time, "My mom didn't."

The rest doesn't need much explaining.

Abbot's jaw shifts as he looks out over the edge of the roof instead of at you. "Is she here?"

"No." You shake your head. "Different hospital. Closer to home." You hesitate, your gaze dropping back to the concrete. "She's still there."

He stays quiet for a moment, his eyes still on the city. "Got it."

The simple answer catches you off guard. No apology. No sympathy. Just an acknowledgment that lets the words sit where they are.

You let out a slow breath. "First time it's followed me into a room like that."

Abbot huffs something that almost sounds like a laugh. "Won't be the last time something hits like that."

"I figured."

For a moment, the two of you just watch the city wake up.

"Difference is," he says eventually, "you didn't stay there."

You glance over at him. "Didn't have much choice."

He gives a small nod. "Still matters."

You don't say anything to that. Instead, you lean back against the railing a little, the first real light of morning filling in the rooftops around you. You're not relaxed exactly, but you aren't holding yourself quite so tightly anymore.

After another minute, you finally push yourself to your feet. "Guess I should let you have your spot back."

Abbot's gaze flicks toward the place you've been sitting before returning to you. "There are worse places to end up after a shift."

The corner of your mouth tugs upward for a second. "I'll take your word for it."

He gives a small nod, hands still tucked into the pockets of his scrub pants.

You turn toward the stairwell a moment later. The adrenaline that carried you up here is finally wearing off, leaving exhaustion to settle heavily into your limbs. By the time you reach the door, you're moving more slowly than when you came up.

Your hand closes around the metal handle, but you don't open the door right away.

"Thanks," you say quietly, not quite looking back at him.

Abbot doesn't answer immediately. He stays where he is for another moment, his gaze fixed somewhere beyond the edge of the roof before finally saying, "Yeah."

You give a small nod to yourself and push the door open. The familiar noise of the hospital rushes in around you, and a second later you're gone.

Abbot remains where he is after the door swings shut, the rooftop falling quiet again. After a while, he exhales through his nose and lowers himself onto the stretch of concrete you'd been sitting on only minutes earlier, looking out over the city as another shift slowly takes shape below.

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Series Navigation: ← Part 1 | Part 2 | Part 3 (coming soon)

[pflh1024]

AFTER EFFECTS

01. Unaccounted Variables

pairing: jack abbot x reader rating: mature (18+) word count: 3.2k

warnings: medical themes • trauma cases • grief • references to parental illness and death • emotional distress • slow burn

summary: the ER has always made sense to you—patients, protocols, and the controlled chaos of every shift. Dr. Jack Abbot, on the other hand, is becoming increasingly difficult to figure out.

a/n: hi!! this is my first time posting on tumblr, so please bear with me if there are any formatting issues or if I accidentally break something while figuring this site out 😭

also, PLEASE appreciate the cover because it took me over five hours in Canva, and I was one inconvenience away from launching my laptop into orbit.

I hope you enjoy this first chapter! If you end up liking it, let me know—I’d love to keep posting the rest of the story over here 🤍

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The emergency department never really sleeps.

It changes, certainly. The voices soften, the waiting room empties and fills again, and the overhead lights dim just enough to blur the edges of everything, but it never truly rests. There is always another chart to review, another patient to evaluate, another monitor sounding somewhere down the hall. The chaos simply changes shape.

You like that about it. Or maybe understand it is the better word. There is a rhythm to this place if you know where to look for it—patterns hidden beneath the noise, priorities that remain the same no matter what comes through the ambulance bay doors. No matter how unpredictable a night becomes, there is always something to do. A question to ask. A problem to solve. It leaves very little room for anything else.

Tonight is no different.

You sign your name at the bottom of the board without looking up, the pen dragging slightly against the surface. The marker is overused, the ink uneven, and you press harder than necessary just to make it legible. Another name added to a list that never seems to get shorter. It’s familiar. Contained.

“Doctor.”

You’re already moving before you fully turn, taking the chart from the nurse with a quick nod.

"Room twelve," the nurse says quickly. "Chest pain. Vitals are stable for now."

You gance down at the chart as you keep walking. “Got it.”

You scan the page automatically, filtering through details automatically—age, onset, history, the pieces that matter and the ones that don’t.

Fifty-three. Male. Onset one hour prior. No prior cardiac history listed.

The hallway stretches longer than it should beneath the fluorescent lights humming overhead, washing everything in the same flat, clinical blue. The sound of your shoes echoes against the tile as you reach room twelve, pushing the half-open door open the rest of the way with your shoulder before stepping inside. 

"Hi," you say immediately, your voice calm and even as you approach the bed. “I’m one of the doctors down here. I’m going to take a look at you, okay?”

The patient nods quickly. Pale. One hand pressed too tightly against the center of his chest. His breathing is controlled in that way people try to control pain—as if staying still enough might somehow keep it from getting worse.

You move closer, already reaching toward the monitor. “When did the pain start?”

“About an hour ago,” the patient answers.

You nod, glancing briefly at the monitor before looking back at him. “Anywhere else besides your chest?”

“No.” He shakes his head, one hand still pressed tightly against his chest.

You keep going from there. The questions come easily, familiar enough that you don’t have to think about them anymore. Your attention shifts between the patient and the monitor as you work through the conversation, sorting through details and deciding which ones matter.

“Doctor.”

The voice comes from the doorway, cutting through the room without ever needing to raise itself.

You don’t turn right away. You finish what you’re doing first, counting the beats beneath your fingertips and watching the steady rise and fall of the patient’s chest before finally shifting your attention toward the door.

Dr. Abbot stands just inside the room, sleeves pushed up to his forearms, one hand resting against the doorframe. He doesn’t look rushed, despite the department around him. If anything, he looks completely at ease, as though he already has a pretty good idea of what’s waiting for him before anyone says a word.

You notice that immediately, though you aren't entirely sure why.

Abbot's gaze flicks briefly toward the monitor before settling back on you. "What are you thinking?"

You glance back at the monitor. "Could be cardiac. Pain's central, started about an hour ago. No history, but he looks worse than I’d expect for reflux."

You hesitate for a moment before adding, “I'd want labs and an EKG before we start assuming otherwise."

Dr. Abbot steps further into the room, pulling on a pair of gloves with practiced indifference. "That should already be happening."

You blink once, the sharpness of his response catching you off guard. "I know."

"Do you?"

He doesn't look at you when he says it, which somehow makes it worse.

You straighten slightly. "Troponins were ordered before you walked in."

That finally gets his attention. He glances at you briefly before returning his focus to the patient.

"Good," he says, but the word sounds more like acknowledgement than praise. "Then stay ahead of it."

He steps beside you again, close enough that you catch the faint scent of hospital soap before turning your attention back to the monitor. You shift to give him room, only to realize a second too late that there isn't quite enough of it.

You angle yourself around him to avoid bumping his shoulder, suddenly aware of where he's standing and the ease with which he moves through the room, as though he’s done it so many times he no longer has to think about it. There isn't any awkward fumbling between you, but there isn't much space either. He doesn't explain what he's doing or tell you where to stand. He simply expects you to keep up.

And somehow, you do.

For the next few minutes, the two of you fall into an unexpected rhythm. You hand him what he needs before he asks for it. He steps aside just as you move closer to the patient. Neither of you says much, but you start noticing little things anyway—every time he moves closer, every brush of his sleeve against yours as he reaches across the bed.

It's not attraction. At least, that’s what you tell yourself.

He's older, closed off in a way that feels deliberate, and carries himself with an easy confidence that’s difficult to ignore. The last thing you need is to start noticing how close he's standing.

And yet, somewhere between handing him supplies and stepping around each other in the cramped room, you’ve already started anticipating what he’ll do next. 

That, more than anything else, catches you off guard.

By the time you step back, the moment has already slipped into the rest of the shift. The patient is transferred upstairs, another chart replaces his on the board, and neither of you says anything about the brief tension that had settled between you only minutes earlier.

The rest of the shift moves on as though nothing happened.

It always does—fast enough that time stops feeling measurable, one patient giving way to the next until the entire shift becomes fluorescent lights, half-finished coffee, and the steady beeping of monitors in the background.

Residents move between rooms with tablets tucked against their hips, nurses call out medication doses across the station, and stretchers roll past before conversations can fully end. Nothing in the emergency department ever really feels finished. One thing simply leads into the next.

Then the overhead speaker cuts through the noise.

"Trauma incoming. MVC. Two minutes out."

The change in the department is immediate. Conversations stop mid-sentence, people straighten, and someone is already pulling on a trauma gown while another reaches for the paperwork. Within seconds, the room is moving again, everyone falling into place with practiced ease.

You’re already moving before you fully realize it, tugging on a pair of gloves as you step into the trauma bay. Your eyes flick around the room—the airway cart, blood setup, ultrasound, the open space beside the bed—making sure everything is where it should be.

Dr. Parker Ellis falls into step beside you. "Vitals?" she asks, already looking toward the ambulance doors.

"Hypotensive on scene," someone answers from across the room. "High-speed mechanism. Significant intrusion."

The familiar rush of adrenaline settles in almost immediately, pushing everything else aside. The exhaustion from earlier and the awkward tension with Dr. Abbot become less important as the room narrows around the patient in front of you.

The patient is wheeled into the trauma bay moments later, blood soaking through the front of his shirt. His breathing is uneven, each inhale catching slightly before the next one comes. You step forward automatically, your eyes moving over him in quick pieces—chest rise, skin color, the dark stain spreading across his side, the way he's guarding his abdomen.

The picture starts forming almost immediately. 

Dr. Abbot comes in behind the stretcher a second later. He isn’t rushed or particularly loud, but his presence is enough to sharpen the room’s focus.

"Alright," he says, pulling on a pair of gloves as he approaches the bed. His eyes move quickly over the patient before settling briefly on Ellis. "What do we have?"

"Male, mid-thirties," Ellis answers without hesitation, stepping up beside the stretcher. "High-speed MVC. Hypotensive on arrival. Airway's maintained, but borderline."

Dr. Abbot nods once, his attention shifting from the monitor to the blood soaking through the patient's shirt before finally settling on you.

"What are you seeing?"

The answer comes easily.

"Uneven respirations. Abdomen's rigid." You keep your attention on the patient, already putting the pieces together. "I'm worried about internal bleeding. I'd want a FAST before he crashes any further."

Dr. Abbot's eyes flick toward you briefly. "Let’s not get ahead of ourselves."

You open your mouth to respond, but Ellis is already stepping in beside the monitor. "Pressure's still trending down," she says, her eyes fixed on the numbers. "We should get large-bore access now and start fluids while imaging gets set up."

"Do it," Abbot says immediately.

The answer comes quickly, without the hesitation or correction you'd just gotten, and you have just enough time to notice before the patient's pressure drops again. The alarms pick up again as a nurse calls out the new systolic.

"BP's falling."

"Hang blood. Move," Dr. Abbot says, already stepping toward the bedside.

You reach automatically for the line setup before his voice stops you.

"Ellis."

For half a second, your hand hovers over the supplies before you step back and let her move past you.

Ellis steps in beside you, taking over smoothly enough that it almost feels expected. You step back without argument and move toward the head of the bed instead.

You adjust the oxygen mask and keep your attention on the patient's respirations while the rest of the room moves around you. Someone calls for blood. Another nurse starts getting transport ready.

Abbot says your name, and when you glance up, he's already looking at you. "Stay on the airway."

"I am," you reply, the words coming out flatter than you intend.

His expression doesn't change. "Then stay ahead of it."

You let the comment go, readjusting your grip on the mask seal and keeping your attention on the patient's uneven respirations until Ellis looks up from the ultrasound.

"FAST is positive. Free fluid."

"Alright." Abbot nods once, already turning toward the rest of the team. "That's our answer. Prep for OR. Let's move."

The room seems to move all at once after that. Orders are called out, blood is rerouted, and equipment changes hands as the trauma team shifts toward transport with the kind of practiced efficiency that comes from doing this every day. You stay with the airway until the patient is wheeled out of the bay, the stretcher disappearing through the doors toward surgery with Abbot close behind.

And then, just like that, the room is quiet again.

The trauma bay resets almost immediately. Blood-streaked packaging disappears into trash bins, surfaces are wiped down, and fresh supplies replace the ones they burned through only minutes earlier. Before long, the steady noise of the department settles back in, as though nothing had happened at all.

You pull off your gloves and drop them into the trash.

"Nice catch," Ellis says as she passes, her shoulder bumping lightly against yours on her way back toward the workstation.

You glance up. "Yeah."

The word feels strange coming out of your mouth. Not because Ellis is wrong, but because when you'd said the same thing only minutes earlier, Abbot had looked at you like you'd skipped a few steps to get there.

The rest of the shift slips by after that, the way it always seems to toward the end of the night. Charts are updated, notes are finished, and patients are stabilized enough to hand off to the day team. Somewhere beyond the ambulance bay windows, the sky starts to lighten, though the fluorescent lights inside the department never change enough to make it feel real.

Day shift filters in gradually, replacing one kind of exhaustion with another.

You finish your last note and sign off on the chart just as Dr. Robinavitch steps up beside the workstation. Unlike most attendings at shift change, he doesn't immediately start clicking through the board. Instead, he pauses for a moment, looking over the department before turning his attention to you.

"How'd it go?" he asks.

"Busy," you answer, leaning back slightly from the computer. "Trauma went to the OR. Positive FAST. Room twelve's stable now. Labs finally came back."

He nods once. "Good catch."

The words are simple enough, but they catch you off guard anyway. "Thanks."

He nods again and turns his attention back to the board, and that's it. No follow-up questions or corrections, no need to pick apart how you'd gotten there. He simply accepts the information and moves on.

Dana appears a few minutes later, moving through the department with the kind of quiet authority that somehow keeps everything running without ever demanding anyone's attention. She checks in with one of the nurses near the station, changes something on the board, and then looks over at you.

"You made it through."

You let out a tired breath through your nose, the exhaustion finally beginning to catch up with you now that the adrenaline has worn off.

"Barely."

Dana nods once, completely unfazed. "That still counts."

You huff out something that might be a laugh, but she's already moving again, stopping beside triage to answer a question from one of the nurses. Nearby, Robby has settled into the board, clicking through charts and working through the handoff you gave him only a few minutes earlier.

The department has already moved on.

Someone calls for blankets in room six. A monitor alarms somewhere down the hall before abruptly going quiet again. Another patient is being brought back from triage.

Your shift is over.

You gather your things slowly, more out of habit than thought. Around you, the ER settles into its daytime rhythm.

By the time you step through the ambulance bay doors, the sky has started to lighten. Not quite morning yet, but close. The cold air catches you by surprise, sharper than you expect after hours spent inside the hospital.

The walk to your car is short and familiar, passing in a blur of footsteps against the pavement and the distant hum of traffic beginning to build beyond the hospital.

When you slide into the driver's seat, the silence feels almost strange. You sit there, your hands lingering on the steering wheel a little longer than necessary, and for the first time since the shift started, you let yourself feel how tired you are.

Usually, the drive home helps. By the time you leave the hospital, you've already put enough distance between yourself and the shift that it stops taking up space in your head.

Tonight, it doesn't.

At first, you try to ignore it and keep driving, one hand resting against the wheel as the quiet hum of the engine fills the car. A few minutes pass before you realize you're gripping the steering wheel a little too tightly.

Then your dad comes to mind, quick enough to catch you off guard, and somehow that leads straight to your mom. The last time you saw her. How tired she'd looked. How every visit seems to leave her a little quieter, a little smaller than the one before.

You swallow hard, blinking against the sudden sting in your eyes.

"Not now," you mutter under your breath, the words automatic and useless all at once.

By the time the tears come, they catch you off guard. Your vision blurs just enough that instinct takes over, your turn signal clicking on as you pull onto the shoulder. The car settles into silence around you, and you keep both hands on the steering wheel, staring straight ahead as you try to get your breathing back under control.

It's not one thing. It never is. 

It's everything at once. The kind of exhaustion that sleep never seems to touch, the pressure of holding yourself together for so long that even something small feels like too much. The shift is over, but pieces of it are still sitting somewhere in the back of your mind.

Abbot's voice.

Let's not get ahead of ourselves.

The way he redirected you without ever raising his voice. The way Ellis had said nearly the same thing a few minutes later and been met with immediate trust instead of correction. You barely know him, and yet you can't stop thinking about the way he looked at you, like he was waiting for proof of something you hadn't earned yet.

You press the heel of your hand against your eyes and force yourself to breathe, waiting for the feeling to pass instead of fighting it. Experience has taught you that fighting it only makes it worse.

Eventually, the tightness in your chest eases into something manageable, and by the time you pull into your parking lot, everything is back where it belongs—quiet and controlled.

The silence in your apartment feels different from the silence in the car. You drop your bag beside the counter, gather your hair back into place after it started falling out sometime during the night, and toe off your shoes near the couch without really thinking about it.

By the time you finally get into bed, you’re exhausted.

Sleep should come easily, but it doesn't. Your mind is still running in too many directions at once.

You close your eyes anyway and wait. Minutes pass. Maybe longer. The low hum of the air conditioner fills the apartment, and every now and then, headlights sweep briefly across the ceiling. 

Somehow, you end up thinking about him again.

Not on purpose. Just pieces of the night replaying themselves.

The way he moved through the trauma bay, calm and unhurried, even when everyone else seemed to be moving twice as fast. The fact that he never had to raise his voice to be listened to. The way he spoke to you, like doing your job well wasn't something to be rewarded.

The thought irritates you immediately, though not enough to make it disappear. If anything, that's the frustrating part. The way he'd looked at you, like he was still trying to figure you out, like he hadn't quite decided what to make of you yet.

You've had harder attendings before. Attendings who yelled, embarrassed residents in front of entire teams, and made people dread coming into work. Abbot isn't one of them.

You let out a quiet sigh and roll onto your side, pulling the blanket closer. The thought is still there, but you're too tired to argue with it anymore.

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Series Navigation: Part 1 | Part 2

[inritum]

reblog and make a wish! this was removed from tumbrl due to “violating one or more of Tumblr’s Community Guidelines”, but since my wish came true the first time, I’m putting it back. :)

[thefirstmarebarrow]

T I B E R I A S   C A L O R E   V I I

And you got me crying out 

oh you left me 

and I’m looking for a reason why (x)