#tfafr

Glory, whose eyes had gotten a little fixed when he started talking, stepped forward, right in front of him. “What he means is, unfortunately the public-”

“What I mean,” Robby said louder, to cover her voice, “is a patient punched a nurse in the building-”

“She was outside.”

“She was by the door in the ambulance bay,” Robby corrected, facing Gloria, “and she stayed to do her job, despite a fractured nose, because she knew we can’t afford even an hour without one of our staff.” Robby turned to the governor. “And that’s how she ended up working past the end of her shift, through the pain, to save dozens of people. But our establishment doesn’t pay her a living wage, and that punch was the last straw. All my nurses are taking four to five twelve hours shifts a week, which is above the national or recommended average-”

“Robby,” Collins spoke, stepping forward to his side. He was raising his voice, he now realized. He didn’t acknowledge her presence, but took a breath.

“And we are months away from being put under corporate management,” he continued, more evenly, “which would deprive this city of its biggest trauma center—because I can assure you, that is the way it goes. Because while the number of lives we save is very high, our patient satisfaction averages are in the toilet. Because people wait eight to twelve hours sitting in a crowded waiting room, and then spend days right here, in the hallway,” he waved to the multiple gurneys lined against the walls “hoping for a bed upstairs. Which we have-”

“Doctor Robinavitch-”

“Which we have,” he said again, talking over Gloria, “but can’t staff because the wage we offer is substandard.”

The silence that followed was deafening.

Robby could hear the beeping of machines and the soft whisper of nurses still working with patients from across the room. Everyone was staring at him : some wide eyed, some pitying ; Collins looked, worried, between him and Gloria.

The governor, who had nodded gravely through all this, had a frown between his eyes. Robby could feel Abbot at his back ; moved closer in the last minute.

Gloria plastered on a polite smile, the skin around her eyes gone tight, and she gestured a hand, good-naturedly, at him.

“As you can see,” she told the governor, with a nod to the journalist, “our doctors are very passionate about the care they provide. The Pittsburgh Trauma Medical Center is a big family, and we have, like many other across the country, suffered greatly in the aftermath of the COVID pandemic. We do wish to improve the working condition of our nurses. ” She smoothed down her cerulean blue jacket in a practiced move. “Our board have put down several requests, for the last three years, for some special state funding to be granted to trauma centers like ours, so that we may provide our citizens with the best healthcare there can be. The nursing shortage is nation wide, but there is no reason Pennsylvania can’t put itself at the forefront, when it comes to creating more nursing jobs and ensuring a higher standard of care.”

She ended her sales pitch with a raised chin.

“Well, that is worth discussing,” the governor answered, nodding with a stiff smile.

A hand closed tightly over Robby’s shoulder, squeezing painfully. He realized the chief medical officer had taken her guest farther, toward the ambulance bay. She was introducing him to Ahmad : his security badge gleamed as he shook the politician’s hand. While she did some damage control, the Pitt crew had moved back to their posts.

Robby could hear his heart beating, a shrill whistling in his ears covering the ambient noise. He’d spaced out again.

“Lets go get some air, brother.”

Robby nodded listlessly. He let Abbot direct him toward the elevator, eyeing automatically the board, the patients and his team as he walked by. But everything seemed in order, and ambulances were temporarily directed to West Penn for the duration of the governor’s tour.

When they reached the rooftop, Robby felt like someone had cut off his strings. He barely made it to the guardrail, draping himself over it, head hung low above his crossed arms.

“Well, that was something,” Abbot declared in his sarcastic drawl.

“She won’t fire me.”

“No. But she can force you to retire.”

Robby turned his head, laying his forehead against the cool metal of the rail to get Abbot in his eyesight. The man was resting near, looking down at him, an amused tilt to his lips.

“Then I’d have nothing to lose,” Robby replied.

Jack Abbot smirk faded, a little nod of acknowledgement his sole answer.

Gloria was smart. She was going to be a pain after this, but there was a reason she hadn’t fired Robby so far. Hell, she’d already turned this thing to her advantage. He hated it, how easily she’d sided with him, like she wasn’t part of the problem.

“You had any day off since Saturday?” Jack asked.

Saturday. That had become the code word for Pittfest. Most of them couldn’t name it, these days. Or they just didn’t risk it around him. Robby wasn’t too sure.

“I was supposed to get Sunday, but there was too much to catch up on,” he answered, rubbing a hand over the back of his neck. “I have a four day break starting tomorrow, but I’ll be here Friday, since I’m missing a senior resident.”

Langdon was another name he’d rather not hear or speak.

“You going to the memorial, Saturday?”

Robby nodded yes. The whole city was in mourning. Not that you’d notice, in the echo chamber that was the ED. Abbot turned his back to the guardrail, resting the hollow of his waist against it. He was mulling over something, Robby could feel it.

“You thought about what I told you?”

Robby straightened, confused. “About?”

“I got an appointment with my therapist tomorrow I need to cancel. I’m needed for a consult I asked for a patient at the VA. You could take it, if you wanted.”

The reflective no hit the back of his teeth. Robby hadn’t been sleeping. His department was a mess, he was loosing his grip on the one thing he could always count on—his professional acumen—and Jake still wouldn’t talk to him.

“It won’t be a problem?”

Abbot’s ability to keep the surprise off his face was commendable. He only blinked his eyes pleasantly. “I’ll shout him a text. Tell him to expect you.”

Robby turned to look over the city, in a silent assent. Next to him, he felt Jack moving ; could see him, out of the corner of his eye, typing on his phone. Rule number one of flighty patients and uncooperative next of kin : the moment you get an agreement, you set things in motion. Don’t give them the time to change their mind.

Robby forced the tension out of his shoulders, pushed himself away from the guardrail and gripped both ends of the stethoscope around his neck. “You sticking around?” he asked.

“Not in the ED” Abbot answered, slipping his phone back in his pocket. “I’ll make a round with the patients upstairs, see if Head and Neck is ready to sign off on its MCI charts.”

They walked back companionably toward the elevator.

“Shouldn’t Walsh do that?” Robby asked once they were inside, his mind catching up slowly. “She was Primary Surgeon.”

Abbot smiled—the closed-mouth one he only displayed in good company. He pressed on the fourth floor button.

“Flores is being a pain, as usual. Emery has been bitching about it for the last two shifts. If I handle this one, chances are I’ll get a very cooperative Trauma Surgeon on consults for at least a week.” He shrugged one shoulder. “Nice change of pace.”

Robby snorted. “You’ll just get bored.”

The elevator doors opened and Jack stepped out. He taped the side of his fist on the metal as he turned before it closed : “I think we could all do with a little boring, right now.”

Back down on the Emergency Department floor, Robby checked prudently for any sign of Gloria before going in. But it seemed the danger had passed.

“Doctor Robby.”

Perlah made a bee line to him. He was walking toward the staff lounge, slowing to let her join him on the way.

“Did Dana really quit? I thought she was on leave.”

Robby nodded noncommittally, glancing at the nurse’s expectant face. Her hijab, today, was green, and her lips were pinched. He poured himself a cup of coffee.

“She’s still on leave,” he confirmed, leading her back out in the hallway. “But she did give her resignation. Gloria talked her into taking two weeks first, to think it over.”

“You have to convince her to come back. We need her. I can’t be a charge nurse.”

“Yes, you can. You did great on Bridget’s day off”, said Robby, taking a tablet from the nearest station. “But we’re not there yet,” he quickly added when he saw Perlah’s expression. “I talked to Gloria. She wants Dana gone even less than we do. She’s been trying to convince her to come back. Hopefully she’ll find the right argument.”

He checked the board with a glance and went to Collins, who was overseeing McKay’s work on a broken arm waiting for the OR. “Hell, Dana might negotiate us an extra security guard for the ED,” Robby told Perlah when she kept pace with him. 

“The anaphylactic shock in South 20 is ready to be discharged,” Doctor Collins reported when she saw them approach. “And I put King, Santos and Javadi on all the extremity lacs that suddenly got admitted en masse” She gave him a pointed look. “So that we can clear up the hallway a little.”

“Who’s on chairs?” asked Perlah.

“Jesse is keeping an eye out, and I’ll be back there now that you are here,” she addressed that last part to Robby. He nodded, after checking the labs of South 20 on his tablet.

“Good work Doctor Collins. Perlah, we can discharge Mr Rodriguez. Make sure he has his script. And ask Bridget if she can get some update from her spies in the ICU : we need to snatch beds while everyone is still distracted with Gloria’s little press tour.”

The next hour went on as usual. The kids made quick work of the injuries that only required stitches and a dressing. They were all now incredibly efficient when it came to treating multiple patients in rapid succession ; and those didn’t even need to be stabilized. The day before, Whitaker—who was currently off—had been halfway through putting an airway before they all realized it wasn’t a task they usually attributed to med students in a standard capacity. But the hell with it : Javadi and him were old hands at it now. And Santos had executed a damn near perfect REBOA, in circumstances so chaotic it would have given pause to even the most seasoned physician.

Doctor King showed herself to be as self-sufficient as Doctor McKay, and Robby made sure to coach them both on some procedures once the ambulances started bringing back trauma patients to the PTMC. It was easy to rely too much on the two R2s, and forget to teach them as consistently as the rest of the lot. Collins managed the tide of the waiting room beautifully, sending him the occasional worried look when she came by ; and Mohan was back to her sluggish pace—a disappointing return to form after her incredible work during Pittfest. Still, she was his best diagnostician.

All in all, things were going great. Or as great as could be in his department. But every time Robby stopped, there was a hollow carved up below his diaphragm that grew wider and wider. It felt like the pressure of its vacuum pulled his insides into a compact knot. Robby hadn’t set foot in pedes since Saturday. He didn’t know how long he’d manage to keep that one up.

“What am I looking at, here?”

Abbot stood beside him, backpack over one shoulder. In front of them was an EVS worker, scrubbing green glitter paint off the floor in the middle of the ED.

“Kid covered himself in arts and craft supplies. Developed a rash. He’s fine,” Robby recounted. “You’re going?”

“Yeah. Off to get some sleep,” answered Jack, inviting him with a motion of his head to follow. “I’m on shift tonight. I’ll be back to pick up the slack.”

“No slack, just overflow,” Robby quipped in a lilting voice. He made sure Bridget saw him walk outside, and signed with a tap on his watch and raised fingers two minutes.

They moved to the side of the ambulance bay, backs to the wall, and Abbot handed him a card-stock paper. It had a name—Dr. Francis Murphy—and an appointment time for the next day.

“Fair warning, I told him were I found you the night after Pittfest. I had a quick session on the phone with him after the whole thing. It wasn’t about you. I have my own issues with the place. But it came up.” Abbot cocked his head to catch his eyes dead on. ”If that’s a bother, you can ask him for a referral.”

Robby shook his head, waving the note pinched between his fingers. “Nah.” He huffed. “It might be easier if he already know the stuffs I’m not telling. But that’s probably cheating,” he added with a rueful smile.

“Far be it from me to keep you from using every trick in the book to ace therapy. Murphy keeps telling me it’s not a competition, but I think he’s just a sore loser.” Abbot bumped his arm. “Just give me a heads up if you tell him anything he can use against me.”

“You sure you don’t want me to ask for a referral?”

“I’d rather you didn’t, honestly.” Abbot stepped away, turning to face him with a serious expression. “I know he can handle your brand of closed-off, since you and I are of the same mold. And he gets a lot of healthcare workers. He knows the drill…”

Robby lifted the card-stock in a lousy salute.

“All jokes aside, I doubt he’ll slip up between what you tell him and what I do. He’s solid.”