"Cops are bringing in a GSW," Mickey the charge nurse announces, setting down the phone he had picked up a moment before. "Five minutes out."
Yuri's eyes flick down to the bottom right of his computer screen. He immediately groans. It's six twenty-three in the morning, meaning there's less than an hour left in his shift. Of course now he's getting the fucking gunshot wound. He's managed to get through the last eleven hours without having to deal with a single real trauma – he's not going to count the GOMER found down at his nursing home and the two drunk fall-and-go-booms – and now, with thirty-seven minutes left in his shift, the fine officers of the law are about to dump a GSW into his metaphorical lap. Who the fuck shoots someone before breakfast anyway?
Let it be a bullshit graze wound, he thinks to himself. Then maybe he'd have at least a slim chance of actually leaving his shift on time. Of course with his luck, it'll probably be a trauma code instead, and he'll end up stuck here for hours dealing with death certificates and calls to the medical examiner's office.
His attending, Viktor, is already asking the clerk to call a level two trauma alert so Yuri turns to Guang Hong, the third-year resident currently seated to his right, and jerks his head towards the trauma bay. "Let's get set up," he says.
A blast of cold air hits him as the trauma bay doors swing open, and Yuri steps inside. It's always freezing in the bay. Well, actually there had been that one week last year when the hospital administration in all their infinite wisdom had turned the thermostat way up, but they had quickly reconsidered the merits of that act when Seung Gil, one of the surgeons, threatened to start showing up to traumas in his underwear. Before Yuri are the three trauma beds, separated from each other by lead-lined dividers and each equipped with their own individual set of resuscitation equipment. Yuuri, the trauma nurse tonight, is already situating himself in front of the middle bed so Yuri doesn't bother asking which one they'll be using.
Yuuri looks up from arranging his IV supplies and smiles at Yuri. Yuri just scowls in response. Yuri actually does like Yuuri well-enough, especially now that the nurse has gotten over his initial tendency to panic the moment shit started hitting the fan. He's seen him do some frankly beautiful work with patients. It's just that his overly affectionate nature grates on Yuri. Also there's his insistence on calling Yuri by the nickname "Yurio", which Yuri earned intern year and has despised ever since. He's a fourth-year now. Is it really too much to ask for his co-workers to even pretend to respect him? He's not saying anyone has to call him Dr. Plisetsky, but his actual first name would be nice.
Yuri sets about pulling a pair of chest tube trays off the back shelf and placing them on the tables situated on either side of the bed. Next to each, he lays a 10-blade scalpel. Hopefully, he won't need them, but he'd rather be prepared. Guang Hong, similarly, is going through the airway equipment, checking the light on the laryngoscope and testing the balloon on the endotracheal tube. As they make their preparations, the rest of the team begins trickling in.
First in is Viktor, who all but waltzes through the trauma bay doors and promptly begins making kissy faces at his husband, Yuuri. Yuri rolls his eyes. The man is patently ridiculous. As an intern, Yuri used to wonder how he'd even made it through medical school let alone through an emergency medicine residency. Then he watched him cric an angioedema patient in thirty seconds flat. Viktor may be ridiculous, but he's also a scary-good doctor.
"You've got this, Yurio," Viktor sing-songs. "It's all you tonight!" Typical Viktor. Yuri still doesn't understand why Viktor chose to adopt him as his pet resident, but he did. As a result, he has been nothing but relentlessly and nauseatingly encouraging since Yuri's intern year.
"Don't call me that," Yuri growls in response. He does, however, appreciate the affirmation that he'll be the one running this trauma resuscitation.
After Viktor arrives Emil, the radiology technician, holding his x-ray plate, and then two women from blood bank, whose names Yuri doesn't know, with their cooler of type O blood. All three take up their usual place off to the side of the immediate resuscitation area. After the women comes Sara, one of the respiratory therapists, who joins Guang Hong in standing at the head of the bed.
Just when Yuri is starting to worry that the patient will beat them to the bay, the trauma surgery team finally starts to arrive. Leo is the trauma chief tonight, which Yuri can't complain about. He finds Leo quite tolerable by surgeon standards. Accompanying Leo is a woman Yuri doesn't recognized but assumes is the trauma intern based on her harried expression and the fact that she has so many pagers clipped around her waist that Yuri honestly can't fathom how her scrub pants haven't fallen down. He ignores the intern, but greets Leo with a nod.
"Who's your attending tonight?" Yuri asks Leo as they both go about donning gloves and shrugging the bright blue protective plastic gowns over their scrubs.
Leo responds with a one-shouldered shrug. "Some new guy named Otabek Altin. Fresh out of fellowship," he says. Ah, the hazard of July in a teaching hospital: a thousand and one new faces, all with names to learn and practice patterns to get used to.
"He any good?" Yuri queries, and Leo just shrugs once more.
"He seems fine, I guess. This is the first time I'm working with him." Leo pauses as the trauma bay doors open once more. Then he inclines his head towards the man who's just entered and adds, "But judge for yourself."
The patient will be arriving any second, but Yuri can't help but spare a moment to give this Otabek Altin a once over. He's short – shorter even than Yuri, who is admittedly not exactly a bastion of height – but built enough under his blue surgical scrubs that Yuri's first thought (after a wholly involuntary damn) is wannabe orthopod. His hair is dark and cut in the same stupid style as Yuri's least favorite co-resident, JJ, which certainly isn't winning him any points from Yuri.
The most striking thing about him, however, is his expression, or rather, his complete lack of one. Yuri watches him glance around the trauma bay, taking in the set-up and various assembled team members, all while wearing the same look of complete and utter impassivity. Even when his gaze makes its way to Yuri, who is obviously and unsubtly sizing him up, his expression remains totally blank.
What's with you, asshole? Yuri almost says, because he is nothing if not a master of first impressions. Something in his face must give his intent away. That, or after four years now, Viktor just knows him well enough to assume. Either way, Yuri feels a sharp jab of an elbow in his left ribs, and decides for once in his life to bite his tongue.
Well, sort of, because while he may not end up calling the new trauma attending an asshole, he does say, "You know we run the traumas until they leave the ED, right?"
Of course, Yuri would argue, that is actually vital to establish. The last thing he needs is some fancy trauma surgeon fresh out of some fancy trauma surgery fellowship thinking that he's calling the shots. In other hospitals, maybe, but not in this one. Here, surgery can have the patient in the operating room. In the bay, they belong to emergency medicine, which means that tonight, they belong to Yuri.
Altin just stares back at him with that same blank expression he's been wearing since he first stepped into the bay and doesn't respond. Yuri can feel his irritation rising. He's about half a second from just saying "fuck it" and laying into him, Viktor and his pointy elbows be damned, when his attention is caught by a sudden commotion beyond the trauma bay doors. A moment later, they fly open once more to reveal two officers in uniform supporting a young man, probably in his early twenties by the look of him, between them. All three are covered in blood, but only the man in the middle has the pale, glassy-eyed, diaphoretic look of a trauma patient.
"He has a left chest wound!" Mickey announces from half a step behind the trio.
"Left-sided chest tube, now!" Yuri snaps, jabbing a finger at the nameless trauma intern. Initially, she just stares at him wide-eyed, and Yuri hates July, with its inevitable crop of new and totally useless interns, furiously. Never mind that he used to be one of them. Then Leo's there, grabbing the intern by the shoulder and shoving her towards the chest tube tray that Yuri had prepared earlier.
The two officers deposit the trauma patient onto the stretcher, and Yuri allows himself a moment to survey the scene. Yuuri has already slammed an IV into the patient faster than Yuri would have thought possible – "16 gauge, right antecubital fossa!" – and is currently getting the patient on the cardiac monitor while Mickey finishes cutting his clothes off. Leo and his intern have the chest tube tray open on the patient's left and are in the process of swapping out their gloves for sterile ones.
Yuri takes a step forward so he's standing directly at the foot of the stretcher. He can still feel Viktor's silent supportive presence off his left shoulder. He looks up at the head of the bed and meets Guang Hong's eyes as he pulls his stethoscope out of his ears.
"Airway intact," Guang Hong announces, starting his primary survey. "Absent breath sounds on the left."
No shit, Yuri thinks glancing at the hole in the patient's chest, easily visible now that Mickey's cut his shirt off. It's just to the left of his sternum, about three centimeters above his nipple. He scans the now-naked patient quickly for any more holes, but as far as he can see that's the only one. He'll obviously need a full secondary survey, but that can wait until after they have the chest tube in.
"Pressure's forty over palp!" Yuuri shouts as he tears off the blood pressure cuff and replaces it with a tourniquet so he can hunt for a second IV site.
Fuck.
A glance at Leo and his intern tells Yuri that they're still too far from starting their chest tube. The intern, in a stunning display of surgical dexterity, has managed the drop the scalpel on the floor. Leo is already moving to procure a new one, but as far as Yuri's concerned, the patient doesn't have the time to wait for that. He needs his tension pneumothorax relieved now, before he decompensates completely and this turns into a trauma code. Needle decompression it is, then.
"Needle him!" Yuri roars at Guang Hong. He's vaguely aware that someone else has shouted the same thing from behind him. For a second, he assumes it was Viktor, before he realizes that the voice had come from the right.
Altin.
Fucking seriously? They can't be more than three minutes into this case and already he's stepping on Yuri's toes. Yuri turns his head slightly, casting his most baleful glower over his shoulder. Altin just gazes back at him impassively. Yuri is rapidly becoming convinced that the man has some sort of congenital defect that caused him to be born without any muscles of facial expression.
"Sorry," Altin says. For an instant, Yuri thinks he sees something in his face flicker, the slightest quirk of the corner of the left side of his mouth that could almost be the start of a smirk or maybe even a smile. It's subtle and so barely there that even in the moment, Yuri isn't certain he's not imagining it. Then it's gone – if it was ever there in the first place – and Altin's face is once again infuriatingly blank. He waves his right hand in Yuri direction, making what Yuri chooses to interpret as a conciliatory gesture, and adds, "It's your patient."
Damn right, it is, Yuri thinks as he focuses the whole of his attention back on the trauma resuscitation in front of him. At the head of the bed, Guang Hong has turned and is frantically digging through the cart behind him for a 14-gauge needle with which to carry out Yuri's order. Yuri makes a mental note to talk to him about that later. If Guang Hong expects to be doing trauma airways, he needs to have decompression needles at his fingertips. In the moment, however, Yuri doesn't have time for helpful and supportive constructive criticism, not when he has a trauma patient with a chest wound and barely a blood pressure in front of him.
Yuri reaches into the front pocket of his scrubs and produces his own 14-gauge needle. Two steps later, he's even with the patient's chest. He feels for his landmarks with his left hand – second intercostal space, midclavicular line – before jamming the needle into the chest with his right. As he pulls the needle back, leaving only the catheter in the chest wall, he hears the satisfying rush of air that tells him his procedure was a success. That should buy Leo plenty of time to walk his intern through the chest tube.
He steps back to the foot of the bed once again, before he runs the risk of losing his grasp on the resuscitation as a whole. Yuuri's gotten the second IV and hung two liters of normal saline wide open. Mickey's rechecking the blood pressure after the decompression. The patient is still awake and more or less talking, even if the most coherent thing Yuri's heard him say so far is his name. Leo and his intern look like they're finally ready to start the chest tube. The intern has a clean 10-blade in her hand and is counting ribs, feeling out the location for her chest wall incision.
"Okay, we're in," Leo announces a minute later. Yuri watches the intern advance the tube through the chest wall between the fourth and fifth ribs and into the pleural space. Leo, in turn, has reached for the Pleur-evac and is in the process of connecting its tubing to the exposed end of the chest tube in order to allow it to drain. Once successful, he unclamps the chest tube, and immediately blood begins pouring out of the tube into the Pleur-evac. "Fuck," says Leo, "That's a lot of blood."
He's not wrong. By the time Yuri looks down at the Pleur-evac where it's sitting on the floor, there's already 500 cc in it with still more pouring out of the chest tube. "Get blood hanging!" Yuri barks at blood bank. "Two units O positive."
The women to their credit already have their cooler open and a moment later, have produced from within it two units of O positive blood. Yuuri and Mickey each grab a unit. Quickly, they disconnect the normal saline running into each IV and replace it with blood. Yuri looks back at the Pleur-evac. There's over a liter of blood in there now, and as Yuri watches, the level reaches and then surpasses the black hash mark representing one and a half liters as well. That means:
"He's going to need a thoracotomy," Yuri says. The bullet probably lacerated one of the major pulmonary arteries. The patient is going to need his chest opened in the operating room by the surgeons for direct visualization and control of the bleeding.
Leo glances down at the Pleur-evac and nods his agreement. "Do you want to put in a cordis down here or in the OR?" he asks Leo.
"What was his pressure after the chest tube?" Leo asks.
"Hundred over sixty," Mickey supplies.
Leo shrugs. "We have good peripheral access. We can get a central line upstairs if we need it."
Yuri nods. "Okay, Emil, let's get a chest x-ray. Then we'll finish the secondary survey and package him for the OR."
Emil moves immediately to slide his x-ray plate under the patient's chest. With some prompting by Leo, the trauma intern begins her careful head-to-toe and front-to-back hunt for additional injuries. It's largely a murmured litany of negative findings aside from hole in the upper chest that they all already knew was there anyway. "Head atraumatic, no C-spine tenderness, abdomen soft and nontender…" Yuri doesn't tune her out entirely, but he does take the opportunity to turn to Viktor.
"Anything to add, old man?" he asks. As much as Yuri hates interference from trauma surgeons, he does kind of legally need the approval of his own attending.
"No," says Viktor, smiling so widely Yuri can't imagine it's not hurting his face. He brings his hands up, clasped in front of his chest. "Oh, Yurio, you did so well. I'm so proud of you!" For a moment, Yuri thinks Viktor might try to hug him and seriously contemplates the pros and cons of putting a scalpel in his carotid. It would almost certainly be eminently satisfying, but Yuri wasn't sure the paperwork, criminal charges, and expulsion from the residency program would be worth it. Also, he'd only be making more work for himself in the trauma bay anyway. Honestly, it's that last thought that gives him the most pause.
He settles instead for: "Don't call me that."
Emil's chest x-ray reveals what they all knew was there: a hemopneumothorax with a chest tube now properly in place. The trauma intern's secondary survey does discover a second hole in the upper back, presumably the exit wound, though Yuri knows better than to speculate on forensics. That's not his job and not mention its own legal minefield.
"OR three is ready for us," Leo announces.
Sara has already switched the patient over to the portable oxygen tank. Yuuri tosses the cardiac monitor into the stretcher. "We're good to go," he says.
"My patient then?" says a low voice into Yuri's right ear. Before Yuri can even nod, Altin is stepping past him, addressing additional orders at the remainder of the trauma bay. His voice is still low, but it's sure, and it commands the attention of the trauma team in a way Yuri can only ever accomplish by shouting. It makes Yuri hate him a little.
He ends up glaring at Altin's back until the patient leaves for the operating room.
Yuri was right, of course. He doesn't leave his shift anywhere near on time. Even after the trauma is out of his bay and into the operating room, he still has six other patients he needs to tie up before he can sign out to Georgi and go home. He admits the old, confused lady for her urinary tract infection to the medicine floor and the fifty-something man with his positive troponin to the telemetry service. The pair of siblings with viral gastroenteritis he sends home with Zofran now that they've finally stopped puking and are tolerating juice and crackers. He does end up signing out to Georgi more than he would have liked – follow up on an ultrasound for pregnant vaginal bleeding and a CT for right lower quadrant pain – but at some point he really does need to leave. He has to be back in what is now less than ten hours for his next shift, and he would like to get at least a few hours of sleep before then.
In the end, it's well after nine in the morning when Yuri finally leaves the hospital. The July sun is blinding as Yuri steps out of the employee entrance. He feels around in his work bag for his sunglasses, cursing to himself when he realizes they're still at his apartment. Not that it's particularly far to his train, but he would rather not be stuck squinting against the brightness the whole way.
"Do you have a long walk?" comes a voice from behind him. Yuri turns to find Otabek Altin dressed in tight jeans and a leather jacket and standing beside a motorcycle. Yuri feels his pulse quicken and tells himself it's just because the surgeon had startled him and definitely not because he currently looks impossibly fucking hot. Sure, he'd looked good in scrubs earlier, but as far as Yuri is concerned, this new aesthetic is on an entirely different level of attractive.
"Just to the train," Yuri manages to respond. He's proud of how his voice comes out, steady and not all like he just nearly swallowed his own tongue. Altin's brow furrows, and Yuri belatedly remembers that he's new to the area. "It's like three blocks," he elaborates.
"I'll walk with you," Altin offers. Before Yuri can protest he continues, "I don't know how it is here, but where I did my fellowship one shooting means more are coming. Someone is always looking for revenge, and if they can't find the guy who pulled the trigger sometimes anyone else will do."
He's not wrong Yuri knows, but that doesn't stop him from protesting. "I can take care of myself." He has pepper spray and everything.
There it is again, that tiny, nearly imperceptible flicker in the corner of Altin's mouth. This time Yuri's convinced it's definitely there. Maybe Otabek Altin is capable of generating facial expressions after all. "I don't doubt that. I saw you in the bay today," Altin responds, and Yuri feels himself go warm. "I'm just saying two is safer than one."
Yuri wants to argue, but he knows he's already blushing furiously, and suddenly he finds he can't bear to look at Altin's stupid attractive self for one more instant. "Fine. Suit yourself," he mumbles, turning around and setting off once again toward the train. He faces resolutely forward, willing the heat out of his cheeks. Behind him, the rasping sound of motorcycle tires being wheeled over pavement is the only indication that Altin is even following him.
They walk the first two blocks in increasingly uncomfortable silence. Around them, the city bustles in the morning sunshine. People flit in and out of storefronts, eager to get their errands done before the oppressive midday heat sets in. It's already at least eighty degrees with a forecast, Yuri knows, for nearly one hundred by noon. There will be more gunshot wounds later today, he predicts, as the heat drives people out of their stuffy apartments and shortens tempers explosively. Sun's out, guns out is the rule of this city.
"Where do you take the train to?" Altin asks eventually, interrupting Yuri's conjecture about the upcoming eventfulness of Georgi's shift. Yuri tells him his stop without turning around, which is why it takes him a solid ten seconds to realize Altin is no longer following him. Eventually, he becomes aware that the crunch-crunch of the motorcycle tires has dropped off. He does turn around then, only to find Altin standing a dozen steps back and holding out a helmet towards Yuri. "Here," he says motioning at Yuri with the helmet. "Get on. I'll take you home."
Yuri gapes at him.
"I live around the corner," Altin adds by way of explanation.
Yuri's never ridden on a motorcycle before, and the entire experience is vaguely terrifying in that sort of rollercoaster way where intellectually you know you're probably not about die but good luck convincing your lizard brain of that. He's pretty sure Altin is going extra slow too for Yuri's benefit, a fact Yuri is simultaneously annoyed by and deeply appreciative of. He can't complain too much, however. It's definitely faster than taking the train, and the delightfully rock-hard abs under his fingertips as he grips tightly at Altin's midsection are a nice bonus as well.
Twenty minutes later, they're outside Yuri's apartment. Yuri lives in a second floor walk-up in an area of town just past the cusp of gentrification. It's still cheap enough to afford on a resident's salary but comes with at least seventy-five percent less chance of murder than if he lived closer to the hospital, and the commute really isn't that bad on most days. Most importantly, the nearest bar-cum-liquor store is less than a block away.
Yuri detangles his arms from around Altin's midsection, with rather more reluctance than he would like to admit, and slides off the bike, unclipping his borrowed helmet as he does so. Otabek is still astride the bike. Yuri faces him.
"Thank you…" he starts, hesitating a moment before deciding to finish with: "Doctor Altin." It sounds weird to him. Yuri's not usually one for addressing attendings by their title and last name. Viktor is Viktor, Chris is Chris, and so on. Dr. Feltsman is Dr. Feltsman, sure, but that's because he's the perennially grumpy chair of the entire emergency medicine department. Even Yuri isn't bold enough to call him Yakov. This is the first time he's meeting Altin, however, and the man did just give him a free ride home. Yuri's willing to err on the side of over-formality at the moment.
Altin's lips quirk again in what Yuri is starting to realize passes for the stoic man's smile. "It's Otabek. Please. Especially since we went to med school together."
Wait, what.
All thought processes in Yuri's brain immediately grind to a halt, then start back up in overdrive, sifting back through his memories of medical school and trying to find even a single one that contains Otabek Altin. He comes up blank, which is surprising, to say the least. Not that Yuri was the most social person at his medical school. Actually he'd spent most of his time oscillating between simply being annoyed by the majority of his classmates and actively wanting to strangle them. However he is pretty damn sure he would remember a classmate who wore leather, rode a motorcycle, and generally just looked like that. Unless Otabek is like that awkward nerdy kid every high school has that suddenly gets super-hot after graduation. That must be it.
"I'm not surprised you don't remember me. I was a fourth-year when you were a first-year," Altin – no, Otabek, Yuri corrects himself mentally – continues. "But I volunteered to help out with one of your anatomy labs that spring. The one day I was there, you were arguing with the instructor over something. I can't even remember what. What I do remember though were your eyes. In that moment, they were so focused, so determined. They reminded me of a soldier's eyes. It stuck with me. After I graduated, I always regretted not getting to know you."
Yuri is going to spontaneously combust. He's going to burst into flames and burn to a crisp right here on the sidewalk, and somehow he's sure his ashes will still find a way to be blushing. Goodbye, Grandpa, he thinks, goodbye, Potya. The cause of death on his death certificate is going to read: immolation secondary to ridiculous compliments from an even more ridiculously attractive man. He wonders if that makes the manner of death a homicide.
Otabek is still looking at him with that faint, barely-there smile. Yuri feels like he should say something, but when he opens his mouth, nothing comes out. He closes his mouth, opens it again, and then closes it again. He's got nothing. His brain is blank except for two words richoching around an otherwise empty cranium: soldier's eyes.
If Otabek is fazed by his lack of response, Yuri can't tell. "I'll see you tonight at work, then?" he asks. Yuri just nods.
He's still standing on the sidewalk five minutes later, long after Otabek's motorcycle has disappeared around the corner.