#romace

9:00 PM

The change in the emergency department happens slowly enough that no one notices it right away.

At first, the noise simply softens.

Conversations at the nurses’ station trail off mid-sentence. Someone’s phone rings twice before it’s picked up. Even the steady rhythm of monitor alarms seems to stretch farther apart, the electronic beeping echoing longer than usual against the fluorescent-lit walls.

The department hasn’t gone quiet.

But it has paused.

Like a room full of people suddenly sensing something in the air.

You only realize something is wrong when Dr. Abbot does.

He’s standing beside the trauma board with his arms loosely crossed, scanning the patient tracking screen the way he always does—calm, focused, every line of text absorbed in seconds. When Dana slowly lowers the EMS phone from her ear without saying anything, Abbot’s gaze lifts instantly.

Dana never hesitates.

She talks fast, efficiently, as if silence itself irritates her.

But now she’s quiet.

Abbot studies her for exactly one second before asking, “How bad?” his voice low and steady as he pushes himself off the counter and steps closer to the desk.

Dana exhales slowly through her nose before answering, the sound sharp with contained frustration. “Multi-vehicle collision on the interstate,” she says, placing the phone carefully on the counter like she’s resisting the urge to slam it down. “Dispatch is still sorting out details.”

Abbot folds his arms again, but his posture shifts slightly, the subtle change signaling that his brain is already reorganizing the department in his head.

“How many vehicles?” he asks.

“Four confirmed,” Dana replies. “Possibly more.”

Abbott nods once, absorbing the information. “Injuries?”

Dana gives a humorless shrug. “Unknown.”

Abbot mutters something under his breath that sounds suspiciously like fantastic before straightening and glancing around the department.

“Alright,” he says calmly, clapping his hands together once in quiet decision. “Let’s get ahead of it.”

The tone is casual, almost conversational. But the reaction is immediate.

Nurses begin clearing stretchers from the trauma bays. Respiratory rolls a ventilator down the hallway. Someone drags a cooler of emergency blood products across the floor, the plastic scraping loudly against tile.

The department pivots from routine to readiness in seconds.

You grab your laptop and follow Abbott into Trauma Bay 1, the familiar weight of the computer tucked under your arm as the smell of antiseptic and sterile plastic fills the air.

Abbott moves through the equipment with methodical precision, checking the airway cart first before testing the suction tubing.

“What’s the potassium on the appendicitis patient?” he asks suddenly, his voice carrying across the room while he flicks on the laryngoscope and checks the battery.

You glance down at the chart. “Three point two,” you answer.

“Replace it,” Abbot replies automatically, setting the laryngoscope back into its slot.

“Already ordered,” you say as your fingers move across the keyboard.

Abbot nods slightly without looking up.

Then he glances toward you.

“You ever worked a mass casualty before?” he asks.

You shake your head. “No.”

“Good,” Abbott says thoughtfully.

You blink.

“That’s supposed to be comforting?”

Abbot hums quietly as he checks the oxygen tubing. “It means you don’t know enough to panic yet.”

You stare at him.

“That might be the worst reassurance anyone has ever given me.”

For the first time since the phone call, the corner of Abbot’s mouth twitches.

He glances at you, one eyebrow lifting slightly. “I’m full of them.”

Despite the tension building in the room, you feel your mouth twitch in response.

Before you can say anything else, the trauma bay doors swing open.

Dr. Shen walks in first. He’s already pulling gloves onto his hands while scanning the room, his eyes flicking rapidly from equipment to stretchers to staff with sharp efficiency.

“What’s the story?” he asks as he steps fully into the bay.

“Highway crash,” Abbot replies.

Shen whistles quietly.

“Well that’s going to ruin everyone’s evening.”

Abbott glances sideways at him.

“My evening was already ruined when you walked in.”

Shen grins widely.

“That’s fair.”

Behind him, Dr. Ellis steps into the trauma hallway, tying her hair back as she surveys the cleared trauma bays and the equipment lining the walls.

“Tell me we’re exaggerating,” she says.

“We’re not.” Dana answers from the desk. 

Ellis nods once.

“Alright.”

She gestures toward the trauma rooms.

“You take Bay 1,” she tells Abbott. “Chen gets Bay 2. I’ll triage overflow.”

Abbot nods easily.

“Works for me.”

You notice he doesn’t ask where you’re going.

He assumes you’re staying with him.

.....

The siren reaches the ambulance bay before the vehicle does.

It rises sharply in pitch as the ambulance pulls closer, echoing through the department like a warning bell.

Every head turns toward the doors.

The moment the ambulance backs into the bay, the paramedics are already moving.

The stretcher bursts through the doors seconds later.

“Male, thirty-two!” one of them calls breathlessly. “Found near the highway crash site—possible debris strike!”

Abbot steps forward immediately. “Trauma One.”

The team moves with practiced coordination, transferring the patient onto the trauma bed.

You slide into position along the counter, laptop already open.

The cursor blinks.

Waiting.

“Patient was outside his vehicle when another car hit the median barrier,” the paramedic continues rapidly. “Debris scattered across the roadway. He took a hit from metal fragments.”

You begin typing.

21:19 — Patient arrival Trauma Bay 1.

The man on the bed groans weakly.

He’s conscious. Barely.

Blood mats his hair along one side of his head where a jagged scalp laceration cuts across the skin. Smaller puncture wounds dot his chest and shoulder where fragments of twisted metal have embedded beneath the surface.

Abbot leans closer.

“Hey,” he says calmly, placing one hand on the bedrail. “Stay with me.”

The patient blinks sluggishly.

Abbot begins the primary survey.

“Airway intact?,” he says.

“Breathing equal.” Respiratory nods.

“Circulation?”

The nurse checks the monitor.

“Heart rate one-thirty. Pressure ninety-eight over sixty.”

Abbott studies the wounds again. “Shrapnel injuries.”

Your fingers move rapidly across the keyboard.

Vitals.

Mechanism.

Exam.

The patient suddenly coughs and then grimaces. “My… chest…”

Abbott presses gently along the ribs. The man winces sharply. The older man’s eyes narrow. “Possible rib fractures.”

He glances toward the nurse. “Portable chest X-ray STAT.”

Across the hallway, Shen is already setting up Trauma Bay 2. Ellis stands near the entrance speaking with EMS, sorting incoming patients. The department is moving faster now, but it still feels manageable.

Controlled.

Then the patient grabs Abbot’s sleeve weakly. “There was… a bang…”

Abbott leans closer. “What kind of bang?”

The man struggles to breathe.

But he manages two words.

“Loud.”

Then—

“Explosion.”

Your typing slows.

Across the room, Shen looks up. “Explosion?”

Abbott studies the patient carefully. “Where?”

The man swallows painfully.

“Bus… station…”

The trauma bay goes silent.

Across the department Dana suddenly calls out.

“Abbot!”

He turns toward the doorway. “What?”

Dana’s voice is tight now.

“Dispatch just confirmed something.”

Abbott waits.

Dana swallows.

“They’re saying it wasn’t a crash.”

Chen straightens.

“What?”

Dana looks toward the ambulance bay.

“Police are reporting an explosion downtown.”

The words settle over the room like a storm cloud.

Abbott’s expression shifts.

Not panic.

Focus.

He pulls on a fresh pair of gloves. Then he looks directly at you.

“Y/N.”

You glance up.

“Yeah?”

“Stay on that chart.”

You nod.

Your fingers begin moving faster.

Outside—

another ambulance siren echoes through the night.

Then another.

Then another.

Chen steps beside Abbott. “How many victims?”

Dana stares toward the doors. “More than we can handle.”

Abbott surveys the department one last time.

The cleared trauma bays.

The waiting stretchers.

The staff already moving faster.

Then he nods once.

“Alright,” he says quietly.

“Nothing we haven’t handled before.”

....

Outside—

three more ambulances pull into the bay.

The first ambulance doors open before Abbot has even finished stabilizing the man in Trauma Bay 1.

The sirens don’t fade this time.

They multiply.

One cuts off just as another rises behind it. Then a third joins in, the sound stacking over itself until the whole ambulance bay seems to vibrate with it. It fills the department with a sharp mechanical urgency that settles under your skin and stays there.

The doors burst inward.

Paramedics pour through in a rush of orange vests, trauma shears, and quick, clipped reports that overlap before the first one has even ended.

“Female, twenty-six, blast exposure, multiple shrapnel wounds—”

“Pediatric male, possible head injury—”

“Another two behind us—”

The controlled readiness of the emergency department doesn’t break.

It transforms.

It becomes motion.

Abbot steps out of Trauma Bay 1 just far enough to see the hallway, his gloved hands already flexing once at his sides as he takes in the first wave of casualties. For half a second, the entire department hangs on that glance of his—Dana at the desk, Ellis at the ambulance entrance, Shen turning toward the nearest incoming stretcher, nurses moving with supply trays already balanced in their hands.

Then Abbot’s voice cuts cleanly through the noise. “Ellis.”

“I’ve got triage,” she answers immediately, already halfway to the doors, one hand lifted toward the incoming paramedics as she starts sorting patients before they’ve even cleared the threshold.

“Shen.”

“Working on it,” Shen says, pulling a face shield down over his eyes as he strides toward Trauma Bay 2.

Abbot points toward the room with two fingers, quick and decisive. “You’re primary on the next trauma.”

Shen grins under the shield, and somehow, even now, there’s still enough of his personality left for him to say, “Finally, something fun.”

Abbot exhales through his nose. “You need better hobbies.”

The woman being wheeled toward Bay 2 starts screaming before the stretcher even stops. It’s a hoarse, animal sound, the kind that rips straight through the center of a room and makes every nerve in your body tighten in response. Her clothes are torn and blackened with soot, and her arms are flecked with cuts where metal fragments have embedded in the skin. Blood runs in thin uneven lines down both wrists.

Shen is at her bedside before the brakes lock.

“Alright,” he says, his voice low and controlled despite the speed he’s moving at. “Eyes on me. Let’s go, people.”

Across the hallway, another stretcher appears. Ellis intercepts it before it can even be assigned.

“Stable?” she asks the paramedic, pacing backward with the moving bed.

“Leg injuries and partial-thickness burns.”

“Bay 3,” she says immediately, and points without hesitation. “Not a trauma room. Move.”

The stretcher veers down the side hall.

Everything is happening at once.

The department fills with overlapping voices.

“Get me vitals.”

“Respiratory to Trauma Two.”

“Where’s the ultrasound?”

“Open blood now.”

“Move that cart.”

You slide back into place along the trauma bay counter, laptop open, the edge of it resting against your forearm as the cursor blinks on the screen, patient note still open and waiting. The bright blue-white glow from the screen catches on Abbott’s glove as he turns back toward the patient already in Bay 1.

But the room hasn’t finished filling.

Another paramedic rushes in hard enough to nearly skid on the floor, steering a second stretcher straight toward the empty side of the bay.

“Male, mid-twenties!” he shouts over the noise. “Blast debris, abdominal injury, deteriorating en route!”

Abbot doesn’t waste a second. “Bring him here.”

The stretcher swings in close, the wheels clipping one of the metal legs of the bedside tray as the team crowds around to transfer. The patient is young—too young, you think automatically, though they all are—and pale beneath the smears of soot and blood on his skin. A makeshift pressure dressing has been strapped low over his abdomen, but dark blood is already blooming through the gauze in a slow, ugly stain.

Abbot steps to the bed as soon as the transfer is complete.

“Alright,” he says, and even now his voice is quiet, not loud. It doesn’t need to be. The room organizes itself around it. “Let’s get to work.”

You begin typing.

21:23 — Second patient arrival, Trauma Bay 1. Male, mid-twenties, blast exposure, suspected abdominal trauma.

The paramedic starts report while still catching his breath.

“Found approximately thirty feet from the blast site. Conscious when we got there, increasingly lethargic during transport. Abdominal pain, hypotension, possible internal hemorrhage.”

“Vitals?” Abbot asks, already cutting away the remainder of the blood-soaked bandage.

The nurse glances at the monitor as leads are snapped on, blood pressure cuff inflating.

“Heart rate one-fifty. Pressure eighty-six over fifty.”

Abbott nods once. “We’re bleeding somewhere.”

Your fingers move faster. Mechanism of injury. Initial vitals. Declining mentation. Suspected internal bleed.

The patient’s eyes flutter open just long enough for him to register the bright lights overhead and the figures surrounding the bed. He groans and tries instinctively to curl around the pain in his abdomen, but Abbott braces one hand gently against his shoulder and keeps him flat.

“Stay with me,” Abbot says, leaning closer, his voice low enough that it somehow still reaches through the noise. “What’s your name?”

The patient swallows hard.

“D—Dylan.”

“Alright, Dylan. I’m Dr. Abbot. You’re in the emergency department. We’re going to help you.”

The man nods weakly and then winces as Abbot palpates lightly along the abdomen. Even the smallest pressure makes him cry out.

Abbott’s eyes narrow.

“Diffuse tenderness. Guarding,” He glances toward the nurse, “Two large-bore IVs. Start fluids. Type and cross. Trauma labs.”

“Already drawing,” she answers.

Across the hallway, Shen’s voice rises. “Pressure dropping— I need another line in here now.”

The sound of Ellis directing triage overlaps with him, efficient and clipped.

“This one can wait. That one cannot. No, not there— put him in hallway one if you have to.”

The room feels tighter now.

Hotter.

Like the air itself is being compressed by the number of moving bodies and urgent decisions being made inside it.

Dylan gasps suddenly, one hand clutching weakly at Abbot’s scrub sleeve.

“My— chest…”

Abbott shifts immediately, his hand sliding from the abdomen up along the ribcage.

He presses gently, making Dylan jerk, pain flashing over his face.

“Possible rib fractures,” Abbot says aloud, both for the team and for you, and your fingers record it immediately. “Ultrasound now.”

The ultrasound machine is wheeled closer. Abbot takes the probe without looking, because the nurse has already put it into his hand before he asks. That’s what the room has become now—everyone moving ahead of each other, not behind.

You are typing, listening, watching, documenting everything.

And then someone slams into you. Hard.

A respiratory therapist trying to cut between the trauma bay counter and the portable monitor catches your shoulder with enough force to knock you sideways into the edge of the counter. Your hip clips the metal corner, pain flashing hot and sharp, and your laptop nearly slips from your hands.

“Sorry—” the therapist starts, already moving.

Abbot looks up instantly.

“Watch it,” he snaps, the words sharp enough to crack through the room. “She’s charting.”

The therapist turns red beneath his mask, mutters another apology, and changes course.

Your heart kicks once hard against your ribs.

Abbot’s attention lands on you for one brief second, eyes flicking over your face, your shoulder, the laptop still secure in your grip.

“You good?” he asks. 

It’s quick. Quiet. But there’s something in it that lands hotter than it should.

You nod once. “Yeah.”

Abbot studies you just long enough to decide whether he believes it.

Then he turns back to the bed. “Time?”

Your gaze drops to the corner of the screen instantly. “21:24.”

The nurse repeats it aloud.

The FAST exam begins. Abbot slides the probe over the patient’s upper abdomen, his face illuminated by the shifting grayscale flicker on the small screen. For a second the room narrows to the image, to the angle of his wrist, to Dylan’s rough, uneven breathing.

Abbott pauses, then his voice drops. “Free fluid.”

The room changes around those two words. No one panics, but everyone gets faster.

The nurse already holding saline drops it onto the tray and reaches for blood paperwork. Someone calls for the trauma surgeon. The second IV line goes in. Respiratory hovers closer in case the patient’s mental status dips further.

You type it all. Positive FAST. Free fluid. Ongoing hypotension. Concern for intra-abdominal hemorrhage.

Dylan coughs, then coughs again harder, blood flecking his lips this time.

Abbot’s eyes lift immediately. “Lung involvement too.”

He steps around the bed and listens to the chest with his stethoscope, head tilted, face unreadable.

“Breath sounds?”

“Present bilaterally but diminished at the bases.” Respiratory answers from the far side. 

Abbott nods, then sets the stethoscope aside.

“Prep for intubation.”

Your chest tightens. The room surges into the next phase before anyone can pause on the decision. Medications are pulled. The airway cart swings open. Respiratory moves to the head of the bed. Across the hall, Shen is dealing with a trauma of his own, and you can hear it in the clipped pace of his voice.

“No, I need that pressure held lower. Lower. There.”

Ellis appears in the doorway of Bay 1 for exactly one second, one hand braced against the frame as she looks between Abbot and the patient.

“Two more red tags incoming,” she says.

Abbot doesn’t look away from Dylan. “Use Bay 3 and the resus room. If they can breathe and answer questions, they wait. If they can’t, they come here.”

Ellis nods once and disappears again.

The emergency department is no longer trying to look like anything but a mass casualty response.

Stretchers line the hall. The usual neat traffic flow is gone. A monitor alarm from triage competes with the hiss of oxygen in Bay 2 and the sharp rip of someone tearing open sterile packaging behind you. Still, Abbot remains exactly what he has been from the second Dana lowered that phone.

Steady.

The nurse holds up two syringes.

“Etomidate ready. Succinylcholine ready.”

Abbot nods. “Push.”

You record the time the instant she says it.

21:26 — Etomidate administered. 21:26 — Succinylcholine administered.

Dylan’s body slackens.

Respiratory steps in.

The laryngoscope passes to Abbot’s hand. He doesn’t rush. He never does. Even now, while the hallway outside is filling with blast victims and someone in Bay 2 is actively screaming, his movements remain economical and exact.

“Tube.”

Respiratory places it into his hand and Abbot advances. The whole room seems to hold still for one impossible second.

Then—

“Cord view.”

Another second.

“Tube’s in.”

Respiratory confirms immediately. “Color change. Bilateral rise.”

You type.

Abbot secures the tube while the nurse tapes it and another starts adjusting the vent settings. For one brief moment, the bay settles around the rhythm of the machine breathing for the patient. Then Dylan’s right hand twitches weakly against the sheet. He isn’t fully under enough to be still.

Abbot looks down. “Give him more sedation.”

The nurse nods and pushes the medication.

Dylan stills again.

You keep typing.

Because if you stop, even for a second, the pace of it all threatens to overwhelm you.

This is what mass casualty charting feels like, you realize—not dramatic in the way television makes it seem, but relentless. A thousand details trying to outrun your hands. Every medication, every procedure, every timestamp demanding to be caught before it disappears into the noise.

The patient from Bay 1—the first one, the man with the scalp laceration and chest shrapnel—has not stopped being your patient just because another one arrived. A nurse is dressing his head wound now while another physician assistant reviews his chest X-ray. Shen is still yelling in Bay 2. Ellis is still deciding which injuries matter most and in what order. Dana is somehow on two phones at once.

And through all of it, Abbot glances toward you again.

You’re still typing.

Still there.

Still keeping up.

The smallest flicker of approval touches his expression.

He doesn’t smile, not really.

That would be too much, too obvious, too soft for a man like him in the center of something like this. Instead he reaches for the next instrument the nurse offers, looks at the chart screen in your hands for one brief beat, and says under his breath, low enough that no one else would catch it unless they were listening for him specifically—

“That’s my girl.”

The words strike through you like a live wire. Your fingers don’t stop moving. They can’t.

But heat floods your face anyway, sharp and immediate, and for one terrible second you are deeply, acutely aware of every inch of yourself in the room.

The laptop in your hands.

The sting in your shoulder from being knocked into the counter.

The bright overhead lights.

The sound of the ventilator.

The fact that Shen absolutely hears everything, even if he pretends not to.

You don’t dare look up right away.

Because if you do, you’re afraid your entire face will give you away. So you do what you know, you just keep typing. Vitals. Intubation. Positive FAST. Suspected internal bleeding. Critical care time ongoing.

Across the hall, someone starts crying in Bay 3.

Not screaming, crying. The kind of sound that carries differently because it comes from a place that has already understood what’s happened.

Ellis’s voice answers it—calm, warm, practical. “I know. I know. Stay with me.”

Dana appears in the doorway of Bay 1 with another update sheet in her hand.

“Police just confirmed a second device,” she says.

The room stills for half a beat. Not because anyone is surprised anymore, but because the number changes things. 

“You’re kidding.” Shen looks up over his patient from the opposite bay.

Dana shakes her head. “No.”

Abbot strips one pair of gloves off and reaches immediately for another. “How many total victims on route?”

Dana glances down at the paper.

“Still unknown. They’re saying multiple self-transports too. Anyone ambulatory is finding their own way in.”

Abbot nods once. “Then we split triage. Ellis keeps sorting the walking wounded. Shen keeps Bay 2. I’ll keep one and call surgery for this one.”

Dana’s eyes flick toward you briefly. “You keeping up?”

You don’t stop typing. “Barely.”

Dana snorts.

“Good. Means you’re awake.”

Abbot’s mouth twitches, just slightly.

He turns back to Dylan’s bed. “Let’s get him upstairs before he bleeds out in my department.”

The room moves again. And so do you.

Because there is still another siren outside.

And another.

And another.