One Hot Mess


Hot Mess:When ones thoughts or appearance are in a state of disarray but they maintain an undeniable attractiveness or beauty.

Urban Dictionary


Whoever fights monsters should take care that they in the process do not become a monster. And when you gaze long in the abyss, the abyss gazes also into you.

Friedrich Nietzsche, "Beyond Good and Evil, Aphorism 146"


"RT Staff on duty... Proceed to... for ABG... "

There is always that moment in the seconds after the disembodied voice has paged for STAT Arterial Blood Gas in the Emergency Room when your hearing becomes heightened and adrenaline starts to pump, because half the time, the follow-up to that page is 'Code Blue at Emergency Room'.

For most people, Mondays were hell. For Doctor Anna Summers, first year General Surgery Resident and still everybody's favorite scut monkey - every day was a look into the abyss. On some days, she could feel the abyss looking back, taunting her.

Interns and Residents have an almost Pavlovian response to the crackle of the PA. Some have sweaty palms, most have accelerated heart rates, both adrenaline induced responses enabling them to spring into action immediately. During her year as an intern, first in line to respond and often relegated to doing chest compressions, Anna had quickly learned to discern the meanings behind the Code colors, with Blue - signifying cardio respiratory arrest - being most common. The rest of the time, she spent it doing scut work; the menial tasks relegated to the lowest member of the Surgical food chain. Even now after having passed her intern's exams and therefore now a full fledged Resident, she still could not shake the ingrained feeling of having to drop everything and answer all codes.

She rubbed at tired eyes, trying to make sense of the orders written by the previous shift's doctors on the sheet in front of her. The words blurred into each other, line after line of chicken scratch made unintelligible by sleep deprivation. Upon hearing the page, her heartbeat began to speed up and she stood. Anna sighed as she stretched, enjoying the little cracks and pops as her body arched. "Further proof I'm still alive," she said wryly to no one in particular.

Grabbing her stethoscope, she nudged the sleeper snoring on a stack of charts. The shaggy head of dark blonde hair jerked upwards and turned to face her. Rheumy eyes blinked back the last vestiges of sleep. "Stat ABG at the ER. You know what that means."

The owner of the shaggy head groaned. "Shit. I hope they don't code."

"Fat chance. We aren't Team Lucky. If you've got to check for blood gas, it's bound to be a croaker."

Another groan, followed by a snort. "True that. Hope you're wrong this time, though. I need a break."

"Don't we all? Gonna get me some coffee. You want some?" offered Anna as she shrugged into her white coat.

"You buying?"

"Maybe. C'mon, Bjorgman, make up your mind, I'm dying here."

"It's vending machine coffee, Summers. Choices are pretty much between take it or leave it. Same cheap swill, different cup."

"That cheap shit is still coffee! How dare you mock the nectar of the gods?"

"Say that to me again when the acid's eaten through your stomach lining. Your ulcer will say to you, 'I wish I had been caused by better coffee'" parried Kristoff Bjorgman with a grin.

"Whatevs," said Anna, walking away.

"I'll take a mocha if they've got it," Kristoff called out.

"Effin' lightweight. Bitter and black is the only way to go," yelled Anna over her shoulder, taking brisk steps towards the elevators.

Around her, the surgical wing of the Maryland Misericordia Hospital was slowly coming alive. Nurses frantically scribbling down notes and jotting down orders. Others were filling up medication sheets, readying for shift turnover. Aides and orderlies wheeling stretchers and equipment into place. Preparing for the morning rush. Anna Summers cut through the fray, making a beeline for the vending machine, the beeps and clicks of monitors and machinery underscoring the hubbub of the shift-turnover rush.

She slipped a couple of quarters into the coin slot, hearing the telltale click of gears falling into place. From within the machine, the faint rumble of coffee percolating, preparing to be spewed into a too-small cup. Anna reached for the steamy brew, inhaling the comforting smell, the warmth seeping into her cold fingers. She punched in an order for a mocha, closed her eyes and sipped quietly at her own drink. For the millionth time in the past six months she asked herself what exactly she was doing here, with her life, with these people. If she had even made the right decision.

A little voice inside her head murmured, 'Happiness is not a fish that you can catch, Anna. You gotta make the decision to let yourself be happy, and you do it.' It sounded suspiciously like Olaf Snow, Psych Resident extraordinaire and her personal pocket of sunshine. Olaf, who was currently admitted in the Medical Wing after some drunken asshole brained him in a bar fight. She gritted her teeth, recalling one of the last conversations she had with him before the attack. He had looked so happy, being able to sit underneath the sun with her - his best friend - away from the pressures and literal insanity of the Psych wards.

Residency had turned them all into walking corpses fueled on most days only by a potent mix of caffeine and adrenaline. Olaf, the most chipper of their motley group of five was perhaps the only exception. Three days ago his boyish smile was infectious, uplifting tired spirits. Their laughter hung in the air with the easy camaraderie of they who have known the hell of death and disease yet willingly walked arm in arm into it every day.

She looked at her reflection in the smudged glass of the vending machine and assessed herself with the critical eye borne of a lifetime of familiarity with one's own features. An image of a young woman, passably pretty, stared back at her with slightly glazed eyes. Freckles were spattered across her nose and cheeks, standing out on skin made pale by the prolonged absence of sun.

A sudden memory, unbidden, had her clenching her thighs inadvertently.

Flashes of Friday night danced on the periphery of her consciousness. Of skin against skin, of hot lips enveloping yearning peaks. Long, cool, fingers sliding over heated skin, dipping lower still. An erotic strobe light illuminating the edges of a memory - of an icy, remote presence who made her feel things. Feel emotions and sensations she hadn't felt in years. Yeah, that made for one helluva night. In the morning, the woman - whoever she was - had gone with nary a trace. If it weren't for the pleasant ache between her thighs and the languorous wellbeing felt only by the thoroughly, fantastically fucked, Anna would have chalked the entire thing up to a dream. A pleasant, X-rated dream. However, the raging hangover the next day and bite marks on her collarbone and inner thighs suggested otherwise.

Shaking off those thoughts, Anna trudged back to the station and handed Kristoff his drink. The big man took it gratefully and sipped, a sigh of pleasure making its way out of his mouth. "Fuel for the fading fire, Summers. Thanks," he said, setting the cup down and reaching for a chart. "You hear about the new Neuro Attending?"

"Huh," murmured Anna distractedly quickly scanning the remaining charts to see if she missed any labs and follow ups. Post-op scut was a pain in the ass at the close of a 24 hour shift. The rapid scramble to make sure Attendings were updated, and all the patients had their labs attached to chart prior to turning over their care to the incoming duty. What am I doing with my life? "Not really. What about?"

"Some sort of Neurosurgical wunderkind apparently. Legend up at Columbia Presbyterian."

"Eh." Anna went back to her charts. Mr. Fowler had already completed his fifth day of Azithromycin, breath sounds were clear, afebrile for the past 36 hours. Possible discharge after Attending's rounds. "What's she doing here, then?"

"Change of scenery, maybe?"

"Yes, because Maryland is also otherwise known as the Scenic State," drawled Anna, setting aside Mr. Fowler's chart and perusing another. Mr. Banks. Fourth hospital day, second day post-open cholecystectomy. Clinically stable but complained of lower extremity weakness last night. Serum electrolyte results pending. Anna made a mental note to follow up on his labs. Kristoff was still yammering away.

"I hear she's supposed to be hot," persisted Kristoff. "Blonde with blue eyes and legs that go on forever."

"Really? All of this you happen to have just heard?

"Alright, she's indescribably hot. I saw her once, and I'm telling you, that face would launch way more than a thousand ships. And those legs. My god, those legs..."

Anne sighed. "Dude, really. I'm trying to work here." Kristoff gave her an injured look.

"Hey, listen, Anna, I know that it's been -" his reply was drowned out by the crackle of the PA coming alive.

"Attention all units!" Around the floor heads popped up like meerkats as residents, interns, and students stopped mid-task and listened, the expression on most faces was attentive. Others looked more apprehensive. "Code blue in room two-fourteen! Code blue in room two-fourteen!"

Anna went very, very, still. As did Kristoff.

"Hey, two-fourteen... Isn't that-?" said Kristoff. Their eyes met, and widened. All sluggishness erased by the sudden pounding of their hearts. Anna thought she could hear a whooshing sound in her ear.

She gulped down the last few mouthfuls of her coffee and took off at a run, Kristoff following close behind. A linebacker during his college days, Dr. Kristoff Bjorgman made for an imposing figure. His speeding presence parted crowds like the Red Sea, people scrambling to get out of the way of his broad-shouldered bulk.

The squeak of rubber soles against slippery tile in beat a staccato rhythm as she bolted down the hall, dodging early visitors and hospital personnel alike. Ducking into the dusty stairwell, she took the steps down two at a time, jumping the last three to push open yet another door leading to another aseptically white hallway, continuing her madcap dash to Olaf Snow's room.


The door at the end of the hall was open - from inside, the sound of a code in full swing. A crush of medical and nursing staff obscured the limp figure lying in their midst.

"What the hell happened?" demanded Anna, rounding the foot of the bed to stand near the monitors at the headboard. She glanced at the vitals flashing onscreen. Bradycardia, blood pressure of 170/110, irregular respiration. O2 saturation at 88%. The relentless wailing of monitors rang in her ears.

"He just... seized, doctor Summers," an intern offered, rapidly flipping through Olaf's chart. "We were doing our morning rounds when he had a generalized seizure. Ariel here was able to intubate," he gestured towards a slight redhead with a greenish stain on her scrubs. "We were about to check for placement -" Anna gently set the diaphragm of her stethoscope on Olaf's thin chest as the intern, Ariel, attached the other end to an Ambu bag and squeezed. Left, right. Clear breath sounds bilaterally. Symmetric chest expansion. The tube was in place. Things were looking up. O2 saturation increased to 91%.

Anna grabbed a penlight from the crash cart, shone it into Olaf's eyes. His left pupil was fixed and dilated, the iris a thin blue rim surrounding it.

She felt her blood turn to ice water in her veins. She flashed his other eye, noting how it responded to the sudden brightness. "Crap, crap, crap, crap, crap, his left pupil's blown," she said, more to herself than anyone else. Looking up, she yelled. "Someone page Neuro! We've got a bleed!" Anna looked around, searching for Kristoff. His hulking presence her comfort.

"Bjorgman, page Belle, ask her to check with Merida if we've got an Operating Room vacant or available for On-Call. STAT cranial CT, inform Radiology, tell them we've got a traumatic brain injury. Make sure Marsh knows where we're going. Someone insert a tube so he doesn't choke, for godssakes. Get a mouth guard in there too."

"On it, Anna," said Kristoff, with reassuring calm. Always dependable, her rock in the ever-changing sea. The team sprang into action, transferring IV lines, hooking the BVM to a portable oxygen tank, mobilizing for transport. Kristoff unlocked the bed brakes with a stomp and pushed Olaf out into the hallway, the interns carrying his peripherals trailing behind, jogging to keep up the pace.

Anna ran alongside, one hand on the railing, the other punching a familiar number into her cellphone. Merida DunBroch, Anesthesiology Resident on duty picking up on the third ring. "Mer, did Belle get through? Olaf's got a bleed. Subdural by the looks of it. We're taking him down to Radio now. Have an OR prepped with a team on standby, we've paged Neuro for a consult. I don't care who you have to piss off to get Olaf scheduled, just do it." She cast a worried look at the slight man they were transporting, dark brown hair in eternal disarray, cowlicks all over the place, skin unnaturally pale against the white bedspread.

"Hang on, Olaf," she whispered.

Though she hadn't done so in a very long time, Anna prayed.


The Radiology department was located deep down in the bowels of the Misericordia. There was an unnatural stillness in the recycled air. Most of the time the only sound heard was the humming of equipment and machinery and the low drone of the air-conditioner, keeping the temperature at a constant, sub-Arctic level. Anna pulled her coat tighter around herself, hands tucked in her armpits in a futile effort to warm the frozen digits.

She looked out through the glass partition to where Olaf lay, head ensconced in the CT Scan machine, Kristoff industriously squeezing the BVM in evenly-timed cycles, keeping his lungs inflated and forcing oxygen into his body. Anna hoped he wasn't as cold as she felt.

"Anna," a low rumble from above, the voice of a veritable giant of a man, towering over. "Prints are here." A rustle of film being mounted onto the viewing boards.

"What have we got, Marsh?" said Anna tiredly, keeping her gaze averted. Afraid to look up, afraid of what she would find in the black and white truth of the cranial imagery.

"Subdural bleed with an intracerebral component," said Dr. John 'Marshmallow' Marshman, Chief Resident of the Department of Surgery waving a meaty hand over the CT slices of Olaf's brain, pointing out a crescent shaped lesion with darkened areas of hemorrhage. "It's pressing against the left optic nerve."

Anna closed her eyes and let out a shuddering breath, steeling herself for all the possible implications. She had to tell his grandmother. Nana would have to know. Oh god, Nana. A wave of nausea rose up her throat at the thought of telling the still sprightly ninety-six year old her beloved boy might never wake up. Nana, who had singlehandedly raised Olaf after his parents' death and - later on, Anna when her dad ran off with his gym instructor, leaving her behind with a barely functioning alcoholic of a mother. Behind her, a door slid open followed by the sharp click of heels at a clipped pace.

"I came as soon as I saw your page, Marsh," a woman's voice, well modulated with the inflections of affluence.

Anna turned towards the speaker and saw the silhouette of a slender figure, backlit by the harsh fluorescent glow from the hallway. Light blonde hair plaited in a single braid hung over the figure's left shoulder, terminating above the pocket of her coat.

Anna squinted to get a better look at the name embroidered on the woman's starched white coat: Elsa Arendelle, M.D. and underneath it, in red stitching; Department of Neurological Surgery.

"Elsa," said Marshmallow, the faintest flicker of relief arcing across his grim features. "Got something to kick off your manic Monday." The figure inclined her head in acknowledgement, walking into the viewing room.

"What am I looking at, Marsh?"

Marshmallow moved closer to the illuminated viewing board, and gave a brief rundown of Olaf's history. "Thirty-two year old Caucasian male, traumatic brain injury secondary to mauling. Third hospital day. Was lucid up until this morning when he had a generalized tonic-clonic seizure followed by hypertension, bradycardia, and respiratory depression."

Elsa took several steps towards the films, pulled the last series off the viewing board and held it up to get a better look.

"Subdural bleed. Probably bridging veins. You can see where it has crossed the suture lines. Ventricles are deviated towards the right, median shift, clearly. It's what's causing your compression symptoms. We have to go in and evacuate. Someone book an OR?"

"All prepped with a team ready. Merida DunBroch's on standby. Anna here called them," Marshmallow replied.

"Did she now," said Arendelle, finally turning to look at her. Anna had the faint impression of dark eyes and high cheekbones in the dim glow of the monitors. "Sure enough to schedule an OR without a CT?"

"Snark all you want, but she called it on history and physical examination, Elsa. It was good medicine. You would do it in a heartbeat."

Dr. Arendelle made a noise that sounded suspiciously like a snort. "Perhaps. But you know when it comes to diagnoses of intracranial bleeds CT is definitive." Bitch, thought Anna.

"She called it. Give the kid a break."

"If you say so, Marsh. Good job, Annie -" Arendelle trailed off, distracted by her phone.

Anna felt her cheeks grow hot. How could Arendelle even be texting at a time like this? The silence stretched on, compelling her to say something just to fill in the space. "Actually, it's Anna. Anna Summers. General Surgery."

"General Surgery? What were you doing in the Medical Wing, then?" Anna could feel Arendelle's gaze boring into her. Damn her. Move into the light where you can look me in the eye while you insult me, damn you.

"Olaf's my friend. Bjorgman and I heard the page and we couldn't not go. And it's a good job we did. Internal Medicine wasn't doing much - if anything - for him. They were perfectly happy with the clearance from Trauma Surgery and the initial CT when everybody knows that subdural bleeds could take days, even weeks to show up." Oh. My. God. Verbal diarrhea, Anna. What in the actual fuck? Inside, Anna's sense of self preservation was screaming for her to cease and desist but a rage demon had gotten hold of her tongue, whipping it onwards. "I mean, what were we supposed to do? Wait for him to stroke out? Wait around for the interns to kill him?" How about you kill yourself now, Summers? Just. Kill yourself.

"You underestimate your interns and have an overly inflated sense of self if that's how you think, Summers," was all Elsa Arendelle said, arching a delicate brow. "That rousing little speech was hardly necessary. Inform his family, get him prepped, and let the OR know I'm on my way." With that, she turned and walked out the door. Anna hadn't even gotten a good look at this person, this woman who would be opening her best friend up. Drilling a hole into his cranium. Saving his life. She shook her head, gathering muddled wits together, and followed Arendelle into the hall. You're an idiot, Summers.

"Hey, wait," called Anna at the Neurosurgeon's retreating back. "You're doing a craniotomy now?"

"Craniectomy," the blonde corrected. "Just drilling the holes isn't going to work, we need more room."

Anna blinked. "You're opening him up..."

"Yes." Arendelle replied without further elaboration, not even breaking her stride.

"I'm scrubbing in, then!"

The figure stilled at the end of the hall, right before pushing open the double doors. "No you're not. You can see him in, but get someone who isn't emotionally invested to assist," said Elsa Arendelle, her tone firm, without turning around. A voice that brooked no argument.

"Emotionally invested my ass! You can't just tell me I can't-" protested Anna, but the doors had already swung shut. "Motherfucker!" she swore, slapping her palms against the wall, anger making her vision blur. She felt a hand on her back and spun around, ready to verbally eviscerate the miscreant. "You get your hands off me you fu-"

Marshmallow stood quietly, an enormous golem in the hall, his expression one of stone. "Marsh. I - I'm sorry," she offered lamely. "I don't know what came over me."

"You're tired. You should get some rest. Being a brat is your release. Happens to the best of us," he shrugged.

"Stop trying to make me feel better, Marsh. I was a total shit and you know it. Hell, Dr. Arendelle knows it. I'm sorry." Anna slumped, all fight gone out of her. This really had been the most exhausting shift.

"Don't you worry about Olaf, Anna," said Marshmallow, once more placing a huge hand on her shoulder, his gruff voice lower than usual. "Elsa's the best at what she does. Zero interpersonal skills, but the best. Olaf couldn't ask for better." With that pronouncement, he turned and left her alone.

Anna leaned against the wall and slowly slid down to sit on the scarred linoleum tiles, hugging her knees close to her chest. What am I doing with my life?


Conceal. Don't feel. Don't let it show.

Conceal. Don't feel. Don't let them know.

Doctor Elsa Arendelle, Maryland Misericordia's newest Staff Attending in Neurosurgery was having a minor breakdown as she stood at the sink, scrubbing up.

You didn't know. How were you supposed to know?

Who would have thought that a random girl in a bar would turn out to be a doctor. A Resident, at that. A Surgical Resident at the same hospital you now work at and therefore under your supervision.

She scrubbed at her fingers, the back of her hands, her palms with almost vicious force, as if the vigor could wash away her sins and remorse.

You've done a lot of less than kosher things in your life, Arendelle, but this one is pretty special. Being passive in the face of injustice makes you an accomplice.

The shock of seeing a familiar face on the stretcher being wheeled into the OR had been jarring. Beneath the bruising and bandages it was him. The guy from that bar. Just this morning she had briefly wondered what happened to the David and Goliath throw down waiting to happen last Friday.

Now you know.

On the way to being well and truly drunk that night, she had been too engrossed in Summers to care about the fight brewing in the corner. All her alcohol soaked brain cells could focus on was getting this girl, this odd, charmingly awkward, interesting girl alone. She had seen the skinny goof being backed against a wall by a hulking troglodyte with dubious hygienic practices. She knew the squirt was about to get the pounding of his life. It would have been a good time to say something.

She got the hell out of there fast. Anna Summers looked restless, ready to pounce and for reasons still unknown to her, she felt the same.

Bullshit. She was hot, and you were interested. Does this mean you like women now?

She let Summers drag her out of the bar and pin her against a parked car. Summers kissed like she meant it, infusing each movement of her lips with the longing she must have felt inside - a mirror of Elsa's own desire. She had her hands buried in Summers' hair, tasting alcohol and the faintest hint of chocolate in the redhead's kiss. Summers' hands were on her ass and she could feel the edge of a door handle digging into her back. There was a vague memory of catcalls and appreciative male voices egging the show on. That promptly brought them crashing down to earth. Too drunk to care, Anna had flipped the men off and walked to the street to hail a passing cab. As she was dragged into the back seat by grasping hands, she had one last glimpse through the bar window, and saw Olaf Snow hauled up against the wall, unable to hold his own against a man easily twice his weight and size.

You let it happen because it didn't concern you. Guess what, genius, now it does. Your one night stand's boyfriend got trashed then thrashed while you were off diddling his girl. You've sunk to new depths with this one, Arendelle. Won't your father be proud?

She brushed at her arms up to the elbows in practiced motions, muscle memory borne out of nearly a decade of doing the exact same thing, day in and day out. Scrub. Rinse. Repeat. As the water ran down the drain taking with it the last suds, Elsa couldn't help but wish it could take her troubled thoughts along with it.

Looking at scans of a person's brain was completely different from seeing the face that accompanied it. Most of the time, it was easier not to attach a face to the film. Compartmentalization. Every physician's defense against getting too involved in a case, to keep their clinical judgement impartial. Right now, some compartmentalization would come in handy, Elsa thought sarcastically. The one time you choose to have random sex, the first and only time you let yourself go crazy and sleep with a girl, she ends up biting you in the ass - both literally and figuratively.

She couldn't help but find this amusing in a distinctly ironic way. God, I'm sick.

Conceal, don't feel. Don't let it show.

Squaring her shoulders, she walked into the OR.

Conceal, don't feel. Don't let it show.

She looked up at the galley as she walked towards the instrument table and donned her gown. Summers, no, Anna was looking down over the proceedings, one arm pressed against the glass, her forehead braced against it. Another Resident was standing behind her, rubbing her back. Bjorgman, was it? She recalled running into him during her patient rounds one time. Good kid. Earnest, responsible. Dependable. Summers was lucky to have him.

Elsa took a deep breath, adjusted the focus on her magnifying glasses, and stepped closer to the operating table. She flexed her fingers, letting snug latex mould to each knuckle and delicate finger. Gauntlets for her battle with the monster in Olaf Snow's head.

Conceal. Don't feel. Don't let them know.

She held out her hand. Not a single tremor. "Knife."


To be continued.


A/N: I'm not normally one for author notes, but I would like to thank yumi michiyo, beta reader and cheerleader extraordinaire. Without her mad skillz this fic would be nothing but a steaming pile of dung. Now go read the masterpiece that is The Nighthawks. Run, don't walk.

Also, hmselsanna for allowing me to use the names she created for her characters, specifically, Anna Summers.

And last, but not least, Requ. If I had never read A Formal Arrangment, I would never have been compelled to write once more. Thank you.

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