Prologue - Elise
The fluorescent lights hum above me with a low, pulsing insistence that’s long since faded into background noise. I move through the corridor with steady, practiced strides, a tablet balanced in one hand and my ID badge swinging slightly against my coat pocket. My scrubs cling damply to my lower back—a byproduct of too many hours on my feet, too many rooms, too many bodies.
Triage is full again.
I don’t need to glance at the monitors above the double doors to know that the board is stacked with yellow tags. Not critical enough for the trauma team, but bad enough to demand time we don’t have. The ER is bloated, overfed with broken limbs and gasping chests, its appetite for suffering endless and gluttonous. I stopped counting how many shifts I’ve done like this a long time ago. They all bleed together. Adrenaline, muscle memory, caffeine.
I turn into Exam Room 3 with a glance at the name on the chart. Dislocated shoulder. The boy on the bed is maybe sixteen, tall and skinny, panic swimming in his eyes and a hoodie stained with blood. He tries to sit up when he sees me.
“Easy,” I say, keeping my voice low and even—more effective than reassurance. “What’s your name?”
“Zach.”
“You fall or get hit?”
“I—I wiped out on my board. Just landed wrong.”
I nod. “We’ll get you some pain meds and pop it back in.”
His face drains to a new shade of pale.
“Look at me,” I say, kneeling beside the bed so I can meet his eyes directly. “It’s going to hurt for a second. Then it’ll stop. You trust me?”
He doesn’t answer with words, just gives a quick nod, jaw clenched tight.
I don’t flinch. My fingers move with precise care as I test the joint, confirming the angle and the dislocation. I give the nurse beside me a quiet nod. “On three,” I say, but relocate it on two.
Zach yelps, then gasps—and then goes limp, the tension falling from his body as the joint slides back into place.
“That’s it,” I say, letting my voice soften. “All done.”
His breath comes in shaky pulls, but he manages a crooked smile. “That was fast.”
“Practice,” I murmur, already peeling off my gloves.
I step into the hall before the door has even fully closed behind me, the hum of my pager cutting through the air with fresh urgency. I silence it with one tap and pivot toward Bay 2. My feet ache. My calves ache. But my mind is sharp. No fog. Not yet.
Janine intercepts me near the crash cart. “Guy in Bay 2’s vomiting blood. History of ulcers, maybe liver, he’s circling the drain.”
“What’s the BP?”
“Eighty over forty and dropping.”
I’m already moving before she finishes. The curtain in Bay 2 is barely drawn; I push through it with my shoulder and take in the scene at a glance. A man in his fifties, thin to the point of transparency, writhes on the bed, dark fluid soaking his gown and the sheet beneath him. Two nurses are struggling to keep him stable.
I snap into action. “Get GI on the line now. We need a scope. Two units of O-negative, wide open. Someone call respiratory—he’s about to crash.”
“Already on it,” Janine replies, tapping her headset.
I grab suction and a laryngoscope, gloves slick before I’ve even touched him. Blood is everywhere—on his teeth, pooling at the corners of his mouth, leaking from his nose. The copper tang coats the inside of my throat, but I don’t flinch.
“He’s coding,” someone says.
“Bag him,” I order. “We’re intubating.”
For the next eight minutes, there’s no room for thought—only movement, instruction, action. I find the vocal cords on the second attempt, slide the tube in, confirm placement. Chest rise. CO2 indicator. Good.
By the time GI arrives, the bleeding has slowed. The transfusion is taking. His pulse has stabilized, barely holding. I step back, peel off my gloves, and toss them into the bin with a snap that feels louder than it should.