(the last of us is out, the Pitt is in)
can't find surrender, and I can't keep control
Ao3 fic | Mature | In Progress | 16k words | realism, angst, and Santos
It's been four months since outing the ED's golden boy, and she's still paying for it. It's not quite how she imagined the start of her residency would be, but she can deal. She always does. Then a shift goes sideways and the dealing stops being so simple. She's thrust back into the spotlight for all the wrong reasons. And this kind of attention? It never comes with anything good. She's been there. She's done that. And she's pretty fucking sure she wants absolutely no part of what's coming next. ------ aka Trinity Santos has had a rough few months, shit hits the fan, and now she has to navigate a whole new ED vibe that leaves her wanting to actually just go back to being the good-ol' department outcast
Sneak peak below! Find the full chapter 1 on ao3
DAY SHIFT - HOUR ONE, 7:00AM - 8:00AM
It’s annoying how nonchalantly adrenaline leaves her body.
Rude even.
It just slips away, there one minute, gone the next.
She digs her finger under the latex band at her wrist and yanks, dragging the blue plasticky material inside out and down with a snap. The first comes off and then the second, hands rolling her left glove into the right without thought. Both get tossed as one floppy ball into the biohazard bin at the trauma bay door without looking, glass door opening in front of her as the gloves float through the air and are discarded with a soft swish.
Maybe it’s genetic.
An inherited gift from her mom - genes that just barely get her a St. Paddy’s Day kiss, but somehow are in overdrive when it comes to deciding when something is simply over.
Something like jumping in on saving a man involved in an MVC. Something like said man bleeding out his face and ass and in a million pieces and basically DOA.
The door closes with a soft mechanical thud and the roar of the corridor hits with an immediate twang in her temple. No matter what’s going on in Trauma 2 - or 1 - the noise there is always rhythmic and controlled. The lights are bright, the sounds are distinct, and people’s voices are firm and consistent. The hall is the opposite. It’s not even something you take note of until you are passing between, like when you don’t realize a room is hot until you leave for another.
She glances back through the glass. Jesse is untangling some wired leads ripped off and discarded before the patient was expeditiously wheeled out and up.
Out and up to OR 4 cause he sure as heck not DOA now.
But she might be.
The adrenaline was there. There was a jittery rush that racked up her heart rate as she met the gurney at the ambulance bay, and there was a comforting hotness of it under her skin as they tried to bring the guy back to life, and it sure as fuck was there and doing its job snapping everything into place while her hand was in his chest.
But then he stabilized.
And her body, like it always does, said, “okay cool, that’s enough.”
It didn’t take into consideration anything about the after - not the fact that they would still have to pack him for the OR, or get the transfer note written and signed, or, after putting humpty dumpty back together again, she would still need to go back out into the ED to muscle through another shift without anything in the tank.
It’s a fucking irish good bye.
All internal, built into her bones, but one nonetheless. A rude ass exit of energy that leaves her to deal with a jumble of voices soft and loud, and the squeaks of gurneys being moved, and the chorus of beeps emanating from at least twelve different machines, and the blare of a neglected phone, and the screech of an incessant overhead alarm, and the weird merging of five different color lightbulbs that flick -
“-in there, Dr. Santos.”
A “hmm?” slips out as her palm hits the Purell dispenser hung on the wall. Cool foam pools in her hand. Her brain lags a beat before catching up. “Oh. Thanks.” Dr. Robby reaches across her and snags some sanitizer himself, falling back in line shoulder to shoulder as he rubs his portion into his hands and down his wrists as they walk.
“You good?” He asks with a glance that could easily transform the question into an interrogation if it was held a second longer.
And if she made direct eye contact with him.
Which she does not.
“Oh, yeah, fine.” It comes out flat, almost defeated - which she isn’t; well, isn’t probably. With a small shake of her head, the twang in her temple migrates to join the ache that’s settled into her forehead at her brows - a forehead that should be stamped with the word “SUCKER” or “MORON” for volunteering for Charlie’s night shift.
A double sounded easy - manageable - but it’s been about as shit as M2. And M2 had 11 people in her cohort quit.
“Thanks for letting me go point on the clamshell,” she adds as quickly as her brain allows, hoping it’s cover enough for her body clearly feeling the effects of being on hour 13 of the work day.
“Oh no thanks necessary - see one, do one, teach one.” He drags in a breath in the way he always does, like he’s forgotten he’s allowed to breathe. Sometimes it’s concerning. “You’ve earned it.”
It sounds truthful, but everything Robby says also sounds kind of calculated. Not in a malicious way, just like a chess sort of way. He’s always two steps ahead and planting sneaky questions in statements and knows how to trap you into learning a lesson or something new when you didn’t even realize there was a test going on.
Attending jiu jitsu.
In the last four months she’s gotten good at spotting it, but hasn’t quite nailed beating him at the game.
She pushes her shoulders up and back, once then twice. The pull from her shoulder blades runs all the way up into the base of her skull, and it hurts good in that certain sorta way stretched muscles do. But, within a second, she realizes that this is something Robby can clearly see too, and could use as some opening for a takedown.
She straightens her posture.
They sidestep an EKG cart as a tech works to push it past them. It’s the one with the fucked left wheel that makes it list enough that the drawers are all open a half an inch, and the whole setup veers off to the side no matter how much you pull it back to center. It’s always best to just give the poor soul in charge of it a wide berth.
“You’ve been picking up lots of patients lately, getting your hands dirty, doin’ good work, so figured you could handle it.” Robby adds, not looking at her at all now, just hands on his stethoscope around his neck, arms hanging relaxed, scanning the ER as they continue to walk.
Her brain offers a red flag on the play, but she’s too tired to do anything about it, and conditioned habits die hard. Like the double, she’s a sucker for this stuff too - for some praise.
“I have been trying to get in on as many -”
” - so then how behind are you on charting?”
There it is.
“A few.” The word comes out before she can calculate something better. Vague enough to mean anything, specific enough to confirm she’s behind. Five faces flash through her head, which is probably half as many as she’s seen overnight, and a third of what actually needs to be documented.
“A few as in three? Or a few as in ‘I'm about to get a call from billing’?”
“Neither?”
Billing doesn’t call, billing emails. So not a lie.
He stops walking. Not dramatically, just stops, and she goes another half-step before her body catches up with the fact that her attending is no longer beside her. She turns back. He’s got his head tilted at the angle that means he’s decided something and his hands have moved off his stethoscope down to his chest, crossed, one clutching his elbow and the other gripped around his bicep.
“Off the board for an hour.”
“But there’s a possible hot appy in -”
“Off the board.” He says it the same way a second time, not even a shift in volume. It’s somehow worse than if he were louder about it.
“Charting. One hour. Notes clean before you touch anything else.”
Her mouth opens and automatically sucks in a lungfull of stale ED air. The argument is right in that breath, right at the tip of her tongue - she’ll catch up later - but somewhere in the exhale the response just disappears. Which is probably because about four seconds ago - when the picture of herself sitting down at the computer flashed in her head - a very real and embarrassing flutter of “oh thank fuck,” bloomed in her chest.
An uninterrupted hour sounds great.
Sitting sounds glorious.
But Robby can’t know that.
“Fine.” The accompanying eye roll is half performative, half true. She’s not sure exactly which part is attached to what feeling, but Robby takes it regardless and begins walking with her back to the Hub.
They pass by South 17 where Todd or Tim - Tom? - the college kid that’s been experiencing side stitches for two hours is still groaning like a baby behind the curtain. Someone else probably started on him when she went off to help with the MVC victim, but she’s sure it’s surgical- and if she can get in on it, she can maybe weasel herself up the OR - especially if Garcia comes down.
She glances at Robby out the corner of her eye, he’s just a pace behind her, watching, but maybe the mandatory hour can start after -
She shifts to the side just slightly, raises her hand to pull at the curtain: “Let me ju-”
“Ihht - ” His hands land on her shoulders, firm but gentle, angles her body back toward the admin station, “- walk.”
✙
The Hub is the loud center of a loud place, but somehow, when you get up close, it’s quiet. Like there is an invisible wall around it, and even if phones are ringing, and people are yelling from Central 7 to South 20, and three doctors are leaning up against the sides of the desk walls, necks craned upward, fighting over who they get next - it’s still not loud.
Or normally, that’s how it is. Today, the walls are being tested.
Muuuwhhhaa, Muuuwhhhaa, Muuuwhaaaa.
“Dana!” Robby coos, stopping at the edge of the desk as she and him approach together. His hands splay across the top and his fingers give it a small drum. She slips past his shoulder and inside.
“Robby!” Dana replies in his exact tone, not moving from her spot firmly planted in the command center, neck angled down with her eyes on her tablet.
She scooches behind Dana and finds a chair, letting her body quite literally melt into it after a descent that could have been a bit more controlled; it’s a hard plop that has the old roller bouncing with a screech and moving a few inches backward. She grips the edge of the desk and drags herself back in front of the set of screens at the work station.
Shaking the mouse with her right, she pulls her badge from the bottom of her scrub top with her left, and drags it to the tap reader - barely enough cord to reach- and manages to hold it just enough to get past login. When she lets it go, the ID slaps back to its home with such intensity that the zziipp rivals whatever the fuck sound is cycling overhead.
Hopefully nobody else noticed.
Her eyes drift back to ED Mom and Dad as Epic loads up - red little circle glowing and rotating on the Blue Pittsburgh Trauma Center Background.
Muuuwhhhaa, Muuuwhhhaa, Muuuwhaaaa.
Robby’s index finger raises upward, giving a twirl: “What’s with the..?”
“Mr. Smitty.” Dana doesn’t look up, but her fingers wander to the cross on her neck, twists it once and then twice. She’s noticed Dana does that, but hasn’t quite figured out how religious she is - not that it matters - but it’s just something to know. Like how you would try to figure out if a coworker has kids, or a partner, or a dog.
“Mr. Smitty-”
“-Mr. Smitty wasn’t happy with our usual hospitality this morning.” She closes something on her tablet, and puts both hands at the edge of it and holds it level into her stomach. Her glasses stay at the bottom of her nose, but she looks up to Robby now. “Rammed the emergency exit by the stairs. Push bars broken. Whole thing won’t stay closed. Maintenance is sourcing a replacement part.”
Dana glances at her - just a half second, but it feels like she’s been caught staring when she shouldn’t. She turns her attention back to the computer.
There’s a long beat of silence that she’s sure is Dana shrugging. “Could be a while.”
“So until then the alarm just-”
“-cycles, yes.” She sneaks another glance at the pair, barely moving her head this time, as she drags her mouse over to ASAP and double clicks. Dana’s staring at Robby with her eyebrows up, but has that look of sympathetic patience. She’s clearly already made peace with the information.
Robby drums his fingers against the desk top again. “Fantastic,” he mutters, nodding his head deep and slow to neither of them in particular. He gives the counter top one last slap before pushing his hands deep into the pockets of his hoodie. “This is great.” Another nod, this time directly catching her eyes that are totally staring at the computer screen doing what was asked of her and not watching the happenings of the ED unfold like a tv drama. “Great.” He adds once more, pivoting away from the Hub to be reclaimed into the bustle of the floor.
Muuuwhhhaa, Muuuwhhhaa, Muuuwhaaaa.
“And Dr. Santos!” He calls, not turning back, only a few strides away, “sign up for that training!”
Fuck.
Her eyes ache as they roll. She’s all scrunched up at the desk, but straightens her neck just enough to get her eyes over the raised counter top behind the double monitors. They only find his back as he rounds the corner by central ten.
“Which training?” She jokes - not even particularly loud.
Still he catches it, yells back over his shoulder, “There’s only one!” and then disappears.
✙
The workstations at the Hub are never clean - except for Dana’s desk of course. The communal spots are best described as trash graveyard war zones. The ones by north are usually much better, but the computers there will sometimes just go black when you’ve done absolutely fuck all to cause it. The ones at West are really the best - but a system upgrade last week somehow fucked with only that station and now all three computers are offline. Now, long sessions of charting are best done at the Hub, but she’s got to at least try to tackle the mess in front of her before her brain can even attempt to settle in for an hour.
The space she picked today isn’t actually all that bad: two medium iced Dunkin cups - both Dr. Shen’s, both finished - a Cookies & Cream Barebells wrapper with some stray chocolate crumb flakes, an opened Flaming Hot Cheetos bag - a diabolical snack at a shared station - and an assortment of different size and color sticky notes in various states of smoothed and creased.
She tosses the cups and the wrapper, tips the keyboard and slides a hand across the desk to brush away any stray crumbs, stacks the stickies, and then steals exactly three Cheetos before rolling the bag closed and casting it to the side.
Whoever owns them won’t mind (or notice).
The longest exhale she’s had all night pours out of her - it carries the spicy heat of the crunchy red dye 40 puffs. The flavor coats the back of her mouth, but she has just the thing to wash it away.
Under the desk, her floppy old backpack is pushed into the corner - didn’t have time to hit up her locker when she came in for night duty. She digs her hand past the stuff that never seems to leave - a spare t-shirt, a flattened granola bar, gum wrappers, some stray Advil Liquid Gels - until her fingers find the Red Bull at the bottom, warm now.
She drops her bag and uses her foot to wedge it back into the depths of the underdesk space as she cracks it open and takes a long sip. The taste is abysmal in a way that screams "dna-altering, but effective" - she's never been a fan, but Whitaker had some in the fridge at home and caffeine is caffeine.
The next sip isn't as bad as the first.
Muuuwhhhaa, Muuuwhhhaa, Muuuwhaaaa.
Epic’s home screen blinks into focus. The sidebar is already a disaster - fourteen patients she’s touched since the last time she’s been able to log on which was a couple hours into her first shift a few hou…
No.
Yesterday.
It’s just past 7:30AM now. Almost all of these are very much yesterday.
Half of them are showing the little red exclamation point that the chart has been started and not complete, missing anything and everything from the report. This is one of the particular cruelties of intern year - she’s not technically allowed to make the final submission on any of it, but expected to get it right up to the finish line nonetheless. And, because it’s going to have someone else's name on it, it has to be pristine - spick and span and detailed and not like a overextended first year cobbled it together at 2:00AM.
“Good charting makes for good outcomes”, but good charting also makes her bored and annoyed and tired and itching to leave all the exclamation points to rot while she hops back into a bloody trauma bay because she became a doctor to save lives. Not write medical narratives.
Billing sees it differently. Billing - Deborah Johaniston to be specific - seems to monitor her EPIC provider page with particular acuity, because she’s now been CC’d on two passive-aggressive billing summary reports sent to Dr. Robby with the subject line of “Outstanding” and a simple message of “Please see the attached and reconcile.”
With 13 patients it’s likely Deb might be sending strike three her way.
She clicks the first one. Opens the note template. Stares at it.
The cursor blinks.
She blinks back.
The other problem with adrenaline leaving so quickly is that it also takes away the words of it all. The case is right there, perfectly intact in her head, replaying like a little movie: he’s a fifty-six year old male says that paramedic, an unrestrained passenger - cause of course, seatbelts be damned in 2026- GCS of six taken in the field; there’s an obvious deformity to the right femur and lower leg, and his right hand’s got a gnarly crush injury, and his beard is seeped in blood from several facial lacs. They caught the tension pneumo quickly, applied a pelvic binder as carefully as they could around a femur that had no business being at that angle, and then his stats tanked.
They popped open the hood like he was the car and not what came flying out of it.
She can hear the crack of his sternum after the anterolateral thoracotomy was extended across and if she thinks about it hard enough, she can even still taste that weird copper-ish flavor the trauma bay always leaves in the back of her throat after big ones like this. She knows it’s probably a trick of the mind - wires getting all crossed after her brain was firing on all cylinders, but a part of her does wonder if maybe it’s aerosolized blood or something.
She’s never had the balls to ask anyone else if it happens to them too.
Her fingers type “Patient presenting is a fifty-six-year-old male…” and stop.
The screen is doing the thing where the text isn’t blurry exactly, just slightly doubled, like her eyes can’t agree on what is there and what it thinks should be there. She blinks hard and holds it until she can hear pressure building in her ears - does it again for good measure. When she opens them, the only thing that seems to have changed is the brightness which does not help one bit. She props her elbows up on the desk, pushes the heel of her palms into her eyes until the inverted image of the screen fades from behind her lids. She tries again, but the doubling just shifts, migrating from the words on screen to the faint reflection of her own face which is a jump scare if she’s ever seen one.
Muuuwhhhaa, Muuuwhhhaa, Muuuwhaaaa.
God she’s so fucking tired.
Dictation.
It doesn’t matter if it’s loud, she is not staring at his screen for an hour. And she needs to go fast.
Dictation is the move.
The mic is clipped to the back edge of the monitor and when she pulls it, it only makes it a few inches. The cord is a tangled mess of black lines, three big knots layered atop each other and twisted around. It’s honestly impressive for something that doesn’t even get used everyday. She pulls it completely out of the USB port and begins picking at it with another big sigh. There is a built in mic on the desktop and she could use it, but there was that Thai order incident and Huckleberry still hasn’t lived it down so it’s best she just gets this one in working order.
She picks at the cord. Gets one loop free. Bounces it in the air in hopes gravity will somehow assist.
“That’s a wire hun - know it can be confusin’ for you bluetooth kids,” the little jest is thrown her way with a small pat on the head as Dana crosses behind her.
She frees the last loop with a sharp tug that has the mic ricocheting off the floor, now unencumbered. She reels it back up, plugs it back into the spot, selects the little microphone on the bottom left of the screen.
She’s in business.
Sinking into the back of the chair, her body comes down too, butt sliding closer to the edge of the seat, ankles crossed and legs stretching out beneath the desk until her shoes hit the modesty panel at the back. Her eyes close without much thought - really just don’t come open after a blink - it will be just for a few minutes anyways.
She clears her throat without opening them.
“Patient is a fifty-six-year-old male, unrestrained front-seat passenger in a high-speed MVC.” She keeps her voice low and even, clinical, the register that med school drilled in until it became automatic. “Brought in by EMS with a GCS of sev - six- obvious deformity to the right femur and lower leg, crush injury to the right hand, multiple facial lacerations, and decreased breath sounds on the left. Primary survey revealed a tension pneumothorax - chest tube placed on arrival with immediate return of air and improvement in sat. Secondary survey showed…”
She trails off. Not because she doesn’t know what comes next, but because the back of the chair is exactly the right height to have her neck slot atop and when she lets gravity take her head back just a little the pull is doing something to the muscles in her neck that feels clinically therapeutic.
“…showed pelvic instability on compression test. FAST exam positive for free fluid. Pelvic Binder applied. Two large-bore IVs established, one liter LR wide open, crossmatch sent.”
She pauses the recording. Her eyelids feel heavy as she pushes them open - it’s too bright - she closes her left. Squinting at the transcription, it looks mostly right. “FAST” is lowercase, and there is a double “showed”, and the thing did catch both “seven” and six, and six is written as “sex,” but none of those little mistakes are worth moving for right now.
Her right eye falls back closed. She presses the button on the side of the mic:
“Clamshell thoracotomy performed under the supervision of Dr. Robinavitch. Left anterolateral thoracotomy extended across the sternum to the right chest. Pericardium opened longitudinally. Cardiac activity initially absen-”
A tablet lands on her keyboard with a clack quickly followed by an unholy shriek of BWEE BWEE BWEE BWEEEEEEEEEE.
Her eyes snap open, her body jolts upright - almost slides out of the chair - almost- one foot catching the base of the roller just in time.
It’s a sticky-keys warning and it’s firing off in a rapid staccato that’s turning heads and darting eyes. Scrambling, she drops the dictation mic; it doesn't quite make it onto the desktop and the cord has enough slack that it swings wide and hits the floor with a plasticky clatter. She yanks the tablet off the keys with one hand and slaps the other over the bottom of the monitor to muffle the shrieks, nowhere in particular just covering as much as she can - unsure where the speaker on the thing even actually is.
"Hey!"
But the nurse who ever so kindly delivered the tablet is already three steps away, ponytail swinging, not turning back, "patient for you," tossed over her shoulder like crumpled trash.
Fucker.
