(Hey there, everyone! I wanted to try something a little different and introduce a new cast of characters! All of this takes place in the same hospital and universe Dr. Lindsay and all my other recurring characters are in, so you may see them referenced here and there. This story is supposed to be an intro for these new characters, so I apologize if you're not feeling the formatting. Regardless, I hope you like these new characters!)
It was just before 7:00 in the evening, the changeover between day and night shift. The ICU quieted down from its daytime pace without going completely still— monitors beeping behind glass doors, a ventilator cycling somewhere down the row, and the lights dropped a notch from their afternoon brightness. The floor was between hands for a few minutes, waiting on the attending who’d carry it until morning.
Three of them stood at the main nurses’ station, the long, curved counter at the center of the unit where every room faced inward.
Nurse Bri Layzell had a clipboard against her hip, settled and unhurried after a full day on her feet. She stood at 5’7”, lean and lightly toned under her navy blue scrubs. Her sandy blonde hair was back in a ponytail gone a little loose over the course of the day, and her brown eyes moved over the rooms and the monitors and came back. A smartwatch on one wrist, an engagement ring on the other hand, bright-colored running shoes on her size 9 feet.
Beside her, Dr. Sloane Buxton leaned against the counter with her arms crossed. At 5’4” she was the shortest of the crew; slim build, put together in a cooler and sharper way than the nurses next to her. Her medium-brown hair, wavy and neat, was pulled half back; her hazel eyes, more green than not under the lights, held steady on the same monitors Bri was watching. Clean neutral polish on her nails, light makeup, a badge clipped at her waistband.
Nurse Megan Keenan stood a short distance back from the other two, closer to the rooms than the counter. She was tall— 6’0”, and athletic through the shoulders, compact and solid, built from years on ice skates as a former D1 hockey player, and dressed now in scrubs, with a pair of comfortable running shoes on her size 11 feet. Her brown hair was up in a plain ponytail, and her deep, bold brown eyes moved between the screens, the doors, and the two women beside her. No makeup, small hoops in each ear, short unpolished nails. She looked more tomboyish and sporty than the other two. She was newer to the floor, and it showed.
The elevator down the corridor opened, and Dr. Ana Agüero came onto the floor. The three at the station noticed her before she reached them.
Dr. Ana crossed the unit at an even pace. At 5’5” she was slim, her straight brown hair swept up and neat, gray coming in plainly at her temples and roots— she didn’t hide it, and it suited her over a face that ran younger than the gray suggested. No scrubs; she wore a tailored outfit with a white coat over the top, a slim gold watch, and clear-rimmed glasses over deep brown eyes. Neutral nails, simple slip-on leather mules, nothing super flashy or showy anywhere. She looked expensive without working at it, and senior in a way the white coat had little to do with.
Ana reached the station and set a slim leather bag on the counter. The other three drew in around her. She pushed her glasses up with one knuckle, looked once down the row of glass doors, and turned back to the three faces already waiting on hers. “Good evening, everyone,” she began, her Argentine accent noticeable. “What do we have?”
Nurse Bri went first, glancing down at her clipboard more out of habit than need. "Room 1, Elise Arnell: 53 year old female. Post-MI. She coded in the ED earlier today, defib times 2, epi times 1, downtime of 4 minutes before ROSC. They took her up to the cath lab after and the procedure went well. She's sedated and intubated now, neuro intact when we lightened her earlier. Systolic's a little soft— she's on a touch of norepi, 4 mics, holding her mean arterial pressure in the mid 60s. Otherwise she's doing well. Cardiology's back at 9 tomorrow to reassess."
Ana nodded slowly, her eyes going to the glass of room 1, where the monitor traced its steady green line. "Wean the norepi as she tolerates. I don't want to be chasing a pressure all night if she doesn't need it." She looked back to Bri. "Good."
Dr. Sloane picked it up from there, uncrossing her arms, "Bed 2 HAD Aaliyah Vaughn, 30 year old female." The past tense landed before the rest of it did. "Dr. Sarah sent her up from the trauma bay around 3:00 this afternoon. Didn't ask— just dumped her on us. High-speed MVC, blunt trauma to the head, chest, and abdomen. She came up unconscious, intubated, and her numbers were ugly from the jump. We kept her going as long as we could, but she ended up coding. We shocked her 11 times, four rounds of epi, worked her 35 minutes. She stayed in refractory V-fib, pupils fixed and dilated. I called time of death at 6:27." Sloane paused. "She's toe tagged and covered. We're just waiting on transport to take her over."
For a moment nobody said anything. Dr. Ana's gaze moved to the closed door of bed 2, the drawn blinds, the room gone dim behind them. Thirty years old. She let it sit there, brief and real, before her jaw tightened a fraction.
"Three o'clock," Ana repeated. "So Sarah knew what she had, and she moved this woman upstairs before she could die in the trauma bay." It wasn't a question. Her voice stayed level, cool, more contemptuous for how quiet it was. "She sends me the ones she's already lost so the death goes on our board instead of hers." She shook her head once. "We'll talk about it another day. You made the right call stopping when you did— 35 minutes on those numbers was generous."
"That's what I figured," Sloane agreed, and moved on. "Bed 3, Valeria Alvarez, 31 year old female. Opioid overdose, brought into the ED earlier today. She seized in the trauma bay— about 20 minutes, per Dr. Lindsay— before they broke it and got her sedated and intubated. She hasn't coded, but her vitals have been all over the place since she came up, and I don't love how she looks." Sloane's mouth flattened. "Honestly, I've got a bad feeling about this one. I'd keep a close eye on her tonight. And there were some neuro deficits noted after the seizure, so neurology's going to come by in the morning to work that up."
"What's she doing hemodynamically right now?" Ana asked.
"Borderline. Soft pressures, tachy to the 110s, and her sats have dipped a couple of times on the vent even after we adjusted her settings." Answered Dr. Sloane.
Dr. Ana studied the room a moment. "Then trust the feeling. Low threshold to call me on her— I'd rather hear about it early than get walked in on it."
Sloane nodded, not saying anything else.
That left Nurse Megan, who'd been quiet at the edge of the group. She straightened slightly when Ana's attention shifted to her. "Bed 4, Michelle Nguyen, 46 year old female. Post-op day 4 from an open appendectomy. She's got a fever, she's tachycardic, and her pressure's on the softer side. She's awake and oriented, but she says she feels worse today than she did yesterday." Megan glanced at her notes. "We've got broad-spectrum antibiotics running, she's getting fluids, and fresh cultures went off to the lab a little while ago."
"What was her lactate?" Dr. Ana asked.
Megan hesitated half a second, clearly a little nervous. "I'd have to check the most recent one..."
"Check it. If it's up, or if it's climbing off the last draw, that changes how worried we are." Ana said it without any edge— a correction offered more than delivered. "A day-4 belly that feels worse instead of better is telling you something. Cultures are right, fluids are right. Just don't let the number get away from you."
"I'll pull it and get back to you," Megan answered.
Dr. Ana straightened and swept the row of rooms one more time, filing it all where she kept it. "All right. Good handoff." She picked her bag up off the counter. "Let's get to work."
The huddle loosened and broke, each member of the team peeling off toward their own end of the ICU.
Over the next little while, the unit settled into the evening. The bright urgency of the day shift completely gone, and what replaced it was quieter and slower— the particular rhythm of our ICU at night, when the work turned to watching, charting, and the small maintenance of people too critical to be anywhere else.
Dr. Sloane took a seat at one of the workstations, logging her notes on Aaliyah and Valeria, her face lit pale by the monitor. Dr. Ana was in and out of the rooms, unhurried, reading her way into each patient the way she liked to at the start of a shift— checking a vent setting here, scrolling a trend line there, and building the picture she'd carry until morning. Nurse Bri moved between beds, practically with muscle memory at this point.
Nurse Megan pulled up Michelle's labs at the far workstation. She found the lactate she'd been sent for and felt something in her shoulders ease: 1.8, down slightly from the draw before it. Not the number of a patient falling off a cliff. Michelle was souring, but slowly, and the antibiotics had time to work. When Dr. Ana passed behind her a minute later, Megan caught her. "Michelle's lactate came back," she reported. "1.8. Trending down, not up."
"Good." Dr. Ana didn't slow much, but she gave a small nod that landed like approval. "Keep watching it. That's the right thing to be tracking." And Ana moved on toward room 1.
Nurse Megan turned back to her charting. She was most of the way into it when Bri drifted over and set a fresh stack of flowsheets on the counter beside her, close but not crowding.
"You did good work on that code earlier," Bri complimented. She said it lightly, her eyes on the flowsheets and not on Megan, giving her room. "35 minutes is a long time. Not everybody keeps their head in the game that long."
Nurse Megan's hands paused on the keyboard. "Didn't matter, though."
"Sure, it didn't change the outcome," Bri agreed, easy about it. "But that’s a different thing than not mattering." She squared the papers, still not making Megan look at her. "Some of them you don't get back even when you did everything right. Doesn't mean you did anything you weren’t supposed to." After a pause, "You holding up okay?"
"Yeah." It came a little too quick, and Megan knew it, and softened it. "Yeah. I'm good…"
Nurse Bri let that stand. She didn't push, didn't make her sit in it— just gave a small nod, like the answer was fine whether or not it was true, and let the subject close on its own. "Holler if bed 3 does anything weird. Sloane's twitchy about that one." Nurse Bri was already moving off as she said it, and the ordinary business of the floor closed back over the moment.
For a while, it was quiet. The monitors kept their steady lines. Somewhere a pump beeped and was silenced. Megan finished her note.
Then the tone changed.
It came from room 1: a sharp, insistent alarm cutting across the calm, the pitch that every one of them knew in their spine before they even looked up. On the central monitor, Elise Arnell's rhythm came apart, the clean line torn into something fast and chaotic.
Dr. Ana was three steps from room 1 when the alarm went off, and she was through the door before anyone else fully processed what was going on.
The monitor told her most of it in a glance: the clean line she looked at ten minutes ago tore into a fast, coarse pattern, the signature sawtooth scrawl of ventricular fibrillation. Dr. Ana pressed two fingers to Elise's carotid and got nothing back. No pulse. The heart on the screen wasn't beating; it was quivering, and quivering didn’t move any blood.
"She's in V-fib, no pulse," Ana shouted. "I need everybody in here, NOW."
Dr. Ana dropped the head of the bed flat, laced her hands over Elise's sternum, and started chest compressions herself.
Elise Arnell didn't look like someone whose heart just stopped. That was the strange, awful part of it— she looked great. 53 and holding it beautifully, a tan she hadn't earned in our building, straight blonde hair still neat against the bed’s padded surface despite the day she had. She had a bright white manicure not too long ago, and it survived the ED code, the cath lab, all of it; her nails reflected the light as her hand rocked with each compression Ana drove into her bare chest. She was fuller-chested, and her body moved with the force going into it, but the face stayed slack, sedated, and unbothered, as though the whole catastrophe were happening to someone else. Dr. Ana continued pumping away at Elise’s chest, her large tits bouncing and jiggling around, her belly rippling out.
The rest of the team was already coming. Nurse Bri reached the doorway first, took in the room in a single stride— Ana on the chest, the rhythm on the screen— and went straight for the code cart, pulling it in behind her with a rattle of wheels.
Nurse Megan was a half-step behind her. For one moment the alarm went through her like a cold wire, the old lurch, her stomach knotting on itself the way it always did in the first second of these. Then she moved through it, the way she was learning to, and her hands found the cart.
"Bri, take the chest," Ana ordered. "I'll run it."
They traded without losing a compression— Ana lifting away in the same instant Bri's hands came down, Bri settling her weight into the rhythm, clean and unbroken. Ana stepped back to the foot of the bed, where she could hold all of it in view at once: the monitor, the patient, her three people.
"Pads," Ana barked.
Megan pulled the defibrillator pads from the cart, peeled them, and set them— one under the right collarbone, one below the left breast— pressing each down firmly, the leads clicking home into the machine. The rhythm redrew itself across the screen in that lead, and it was the same as before: coarse V-fib, the tall, ragged, disorganized waveform of a heart doing everything except what it was supposed to do.
At the head of the bed, Dr. Sloane slipped in without being asked. She took hold of the endotracheal tube already seated in Elise's throat, checked it at the lip, reconnected the ambu bag, and began to breathe for her— controlled squeezes of oxygen worked around the compressions. "Airway's secure," Sloane reported. "I've got the head."
Nurse Megan drew the first milligram of epinephrine and capped the needle, holding it where Ana could see it. Ready, not given.
Dr. Ana's eyes stayed on the monitor a moment longer, reading the coarse waveform. Coarse was better than fine. Coarse still had something to work with. "Alright, charging to 200." Ana called out.
She reached for the defibrillator and thumbed the charge. The machine answered with its signature high-pitched, rising whine, winding up toward the shock. Bri still delivered deep, strong chest compressions, Sloane still bagging, Megan holding the epi, all of them waiting on the tone to peak.
"Clear," Ana’s voice surged once the defibs were charged and good to go.
The team came off the patient all at once— Bri lifting her gloved hands from Elise’s bare chest, Sloane leaning back off the airway, everyone's weight pulling away from the bed in the same instant. For a half second Elise lay untouched, alone in the center of the room with the charge waiting.
Ana pressed the shock button.
The current went through the 53 year old hottie, and her body answered instantly. Her legs tensed hard, feet flexing at the ankles, her toes curling tight and involuntarily, showing off the deep, thick, soft wrinkles throughout the soles of her size 8 feet as the jolt raced down through her. Elise’s shoulders jerked against the bed’s padded surface, then let go, and she dropped back into the bed, motionless again, everything that seized in her going loose all at once.
Every eye went to the monitor. The line scrawled its noise for a second or so as the machine caught back. It settled, and it was the same as before. Coarse V-fib. Tall, ragged, and disorganized. The shock did absolutely nothing.
"Still V-fib," Ana stated. No heat in it, just the read. "Resume compressions."
Bri's hands came back down without hesitation, and the rhythm picked up where it left off, her weight driving into each one. Sloane resumed bagging at the head, oxygen moving again in time with the chest.
"Epi, one milligram." Ana ordered.
Nurse Megan had it ready. She pushed the milligram she was holding into the line and flushed it after, the drug on its way now, and said, "Epi's in."
"Good." Ana's eyes stayed on the monitor a moment longer, then went back to the patient. Two minutes of compressions ahead before the next rhythm check, the code settling into its cycle around Elise's still, composed face.
The code settled into its grim rhythm. Nurse Bri pumped away at Elise’s bare chest at a hard, even clip, her arms locked, her shoulders stacked over her hands, driving her weight straight down. The compressions came in a steady mechanical cadence— thudthudthud, each one sinking deep into Elise's chest and letting it spring back before the next fell. Two inches down, full recoil, over and over. Her chest caved under each stroke and rebounded, and with every downstroke her belly rippled outward, the force of the compression traveling through her. Elise’s big, perky tits jiggled around in perfect sync with Nurse Bri’s compressions. The bed shifted faintly with the tempo. It was violent, but unfortunately necessary.
"Good compressions, Bri," Ana complemented, watching the depth. "Stay right there."
Dr. Sloane breathed for her from the head of the bed, a squeeze of the bag every few seconds, her eyes moving between Elise's chest and the ET tube. Nurse Megan stood ready at the crash cart, the used epi syringe set aside, her jaw tight and her eyes fixed on Bri’s hands working Elise’s chest.
The clock on the monitor counted the cycle down. Dr. Ana let it run, giving the compressions and the epi their two minutes to do what they could, her attention split between the patient and the timer, reading the room the way she read everything.
"Coming up on two minutes," Ana called out as it wound down. "Charging again— 300 this time. Keep going till I call it, Bri."
She reached for the defibrillator and thumbed the charge. The machine took the command and began to climb, its high-pitched whine rising again through the room, going toward 300 joules while Bri stayed on the chest— thud, thud, thud— the charge building in the background as the code ensued.
"CLEAR," Ana called out once the defibs were ready to go.
The team came off her again— Bri's hands up off the chest, Sloane back from the airway, Megan staying back.
Ana delivered the shock once she ensured everyone was clear of Elise.
It discharged with an ugly, heavy KA-THUNK, and Elise's body was thrown with it. Her torso heaved up off the bed, her arms flung out and slapped back down, her whole frame tossed and jarred by the electric current tearing through her. The bed rocked under the force. Then the charge released her and she dropped, dead weight, back down onto the bed— arms askew, head lolled, everything gone slack in an instant.
Every eye shot to the monitor. The screen threw its noise for a split second, then cleared and drew the rhythm plain. Coarse V-fib, exactly what it showed before the shock. 200 joules didn’t touch it, and now 300 joules didn’t either.
"Still V-fib," Sloane shook her head, reading it off the screen.
"Coarse," Ana added, her eyes on the same waveform. She didn't reach to resume anything yet. For a moment she just looked at it— the rhythm that wouldn’t budge.
"Let's rotate," Ana directed. "Megan, take over."
Bri lifted her hands and Megan stepped in without a break in the rhythm, dropping her weight onto Elise's chest and picking the compressions right back up, her strong athletic hands pummeling Elise. Her jaw was set and her pretty brown eyes were a little wide, the tension sitting on her plainly, but her hands did the job and did it well. Elise’s chest caved and sprang under each downstroke, her belly rippling out with the force, tits bouncing around again.
Nurse Bri moved to the cart, free now, ready for whatever came next.
"Good," Ana nodded, watching the depth of the compressions for a moment. "Right there." Her eyes went back to the monitor, to the coarse waveform still scrawling its ugly line, then to the clock counting the cycle. "We're going again. Charging to 360." She reached for the defibrillator and thumbed it up. "And I want another epi. One milligram."
"Epi, one milligram," Bri called out, already drawing it up. She had it up in a moment, pushed it into the line, and flushed it after. "Epi's in."
"Good." Ana nodded, succinct and to the point.
The defibrillator climbed toward 360 joules, its usual whine rising through the room while Megan stayed on Elise’s bare chest, delivering deep, violent chest compressions.
The cycle ran itself out, the minutes blurring into one another, compressions holding to the end, and Dr. Ana called the clear.
Hands came off Elise, the room pulled back from the bed. Ana then delivered the shock.
This one moved through Elise differently. There was no heave, no toss— just a fast, fine shiver that ran the length of her body that came and went in an instant. And as it passed, Elise’s eyes drifted open. Not all the way, just half— the lids parting to show a sliver of blue underneath, fixed on nothing, staring up at the ceiling with no awareness behind them. It was the emptiest thing in the room, and for a second it stopped the breath in more than one throat.
No one reached to close them. Every eye was already on the monitor.
The screen resolved out of its noise, and there it was, unchanged: coarse V-fib. Three shocks now, three rounds of epinephrine, and the rhythm scrawled the same ragged, disorganized line it showed at the very start.
"Still V-fib," Sloane noted quietly.
Dr. Ana looked at it, and this time she didn't call for anything.
For a second nobody moved. Nurse Megan looked to Dr. Ana, already shifting her weight forward, ready to drop back onto the chest and resume CPR. It was the rhythm of it; you worked until someone told you to stop.
"Hold off," Ana spoke, quiet and even. Megan stilled.
Ana turned to Sloane. "How long has she been down?"
Sloane checked, though she already knew. "About 15 minutes. Refractory V-fib the whole way— three shocks, three rounds of epi, no change. Pupils are fixed and dilated."
Ana didn't answer right away. She looked at Elise— the half-open eyes, the blonde hair still neat, the bright white nails, the composed face that never once caught up to what was happening inside her— and she let Sloane's answer settle, taking the full measure of it before she moved.
Then she reached down and stripped off her gloves.
"That's it," Ana stated. "We've done everything we can for her tonight." Her voice stayed level and certain. "Time of death, 7:43 P.M."
The room let go around her— hands coming away from the bed, the code cart going quiet, the work simply over.
"Let transport know we have another. She goes down to the morgue with Aaliyah now." Ana told the team.
For a moment after the time of death call, the room stayed as it was, everyone still gathered around a patient who no longer needed them.
Then it began to come apart, quietly. Sloane reached up and silenced the heart monitor, and the jagged, chaotic line vanished from the screen, taking its noise with it. She leaned over the head of the bed and disconnected the bag valve mask from the endotracheal tube, setting it aside; the small hiss of forced oxygen stopped, and the room went even quieter.
Dr. Ana was already moving. She dropped her gloves in the bin and stepped out toward the workstation, the paperwork of a death waiting for her, her mind visibly turning ahead to the calls she owed— the family/next of kin, most notably. Sloane went with her a moment later, peeling off toward her own charting, and the room cleared until it was down to the two nurses and the recently deceased woman in the bed.
Nurse Megan didn’t move. She stood where she ended the last round of compressions, looking down at Elise— at her half-open blue eyes, the neat blonde hair, the almost peaceful face, even now, looked like it belonged to someone who should be fine. Megan looked a few seconds too long. Something behind her own eyes went flat and far away, the particular stunned stillness of a young nurse processing how quickly a living patient becomes a body.
Nurse Bri saw it. "Hey. Megan." Her voice was easy, low, pitched to reach her without filling the room. Megan's eyes came up. "Why don't you help me get these leads off of her."
It wasn't really a question, and it wasn't really about the leads. It was a rope thrown, dressed up as a task— something to do with her hands, a reason to look somewhere other than that face. Megan took it. She blinked, drew a breath, and came back into her body, moving around to the far side of the bed.
The two nurses worked together in the quiet. Bri peeled the electrodes away one at a time, and Megan followed her lead, easing the leads free and coiling the wires, the small tasks that come after— the ones nobody teaches you until you’re on the job. Bri kept close as they went, her movements unhurried, letting Megan match her pace.
"You kept your head the whole time she was down," Bri complimented, not looking up from her hands, laying it out like a fact rather than a comfort. "That's the job. That's all this job ever is." A moment passed, another electrode lifted away. "The rest of it, you feel later. On your own time. Not in here."
Nurse Megan didn't answer, but something in her shoulders let down a fraction, and she kept working, staying close to Bri's side as the two of them tended to what was left.
A couple of hours later, the unit found its way back to normal (or its own version of normal). The urgency of Elise Arnell’s code was well behind them now, folded into the night like everything else, and the floor returned to its slower work— the watching, the charting, the quiet maintenance of the living. Elise's room stood dark and empty at the end of the row, stripped and cleaned, and bed 2 sat empty beside the memory of Aaliyah. Two of them gone in a single evening. The ICU absorbed it the way it absorbed everything, and kept going.
The team drifted back to the main station between rounds, the way they did at the start of the shift, though the mood changed in the hours since. Nurse Bri worked through her charting with the same steadiness she brought to everything. Nurse Megan sat a seat down, quieter than she was at the start of her shift, but back in her body, doing her notes, steadier for having been kept busy. Dr. Sloane came and went, checking her patients, her eyes lingering a little longer on bed 3 each time she passed it. And Dr. Ana moved among all of it, in and out of the rooms, the calls to Elise's family behind her now, the night's losses filed where she kept such things.
The two who remained on the board that night would go on to write very different endings.
Michelle Nguyen, in bed 4, turned the corner she was circling. The fever that worried them broke over the days that followed; the antibiotics found their mark, her pressures firmed, and the day-4 belly that was trying to tell them something quieted down to nothing. She stayed in the unit a few more days for observation, then moved out of it entirely— off the ICU, onto a floor bed, and eventually out the front doors five days later with discharge papers instead of a toe tag, a full recovery from a post-operative sepsis that could just as easily have killed her. The careful, unglamorous management held.
Valeria Alvarez, the OD patient, didn’t get the same ending. The bad feeling Sloane carried about bed 3 proved true, as those feelings too often did. Overnight and into the next day she slipped further from them rather than closer: her vitals eroding, the ground she never quite gained giving way beneath her. The following afternoon the team fought to hold her together and ultimately couldn’t; she coded, and despite everything they tried, she was unable to be brought back. She was pronounced at 1:13 that afternoon, on a different shift, in front of the daytime ICU crew— but it was Sloane who saw it coming the night before, standing at this same station, saying she didn't love how the woman looked.
Overall, it was just another night in the ICU for our team.
