Yuri is going to strangle the new trauma surgeon. He's going to wrap an entire length of IV tubing around his neck and pull until his whole stupid face pops off. Then he's going to resuscitate him just for the satisfaction of murdering him again. He's thinking of maybe having him drawn and quartered the second time, or possibly flayed alive.
It's been two weeks since he first met Otabek Altin, and Yuri's opinion of the trauma surgeon is currently in a death spiral. He knew this was coming; it was inevitable really. Sure, the ride home and the weird compliments and the muscles had earned him some initial brownie points, but in the end, surgeons always turn out to be surgeons. Why the ability to cut out an appendix seems to automatically transform people into self-righteous pricks, Yuri will never understand, but holy shit, it does. Somehow, it really, really does.
Currently, however, the source of Yuri's ire is nowhere to be found. Fortunately, Leo is serving as a passable surrogate. They two of them are now standing about five centimeters shy of being literally nose to nose in the trauma bay. No one has thrown any punches yet, but their original reasonable discussion of alternative clinical practices has long ago devolved into a shouting match.
It's not like Yuri was having a particularly good day to begin with. It's only three in the afternoon, but Yuri's already had three codes and two additional ICU admits plus a stroke alert that ended up getting lytics. He's intubated twice and walked the intern through a central line. He's tired and hungry and hasn't peed in nine hours. Yuri has neither the time nor the energy for dealing with surgery's bullshit, and yet bullshit is all he's getting.
"I'm sorry, Yuri, but we want a pan-scan. My attending –" Leo is not subtle about the emphasis "—wants a pan-scan."
The patient in question is a 4-year-old autoped, although to say that the boy was actually hit by a car seems to be a wild overstatement. Per bystanders, the car had been turning left from a complete stop and had clipped the boy with the very edge of its front bumper. The kid had been knocked to the ground, but after some initial tears, had been up and doing veritable laps around the block by the time medics had arrived.
Of course, now that the kid is lying in the trauma bay, surrounded by strangers wielding needles and terrifying-looking medical equipment, he's completely inconsolable. As far as Yuri's concerned, he's clearly more scared than actually injured. Sure, he cries when you exam his neck and cries when you exam his abdomen, but he also cries the moment someone in a white coat or scrubs comes within five feet of him. What he really needs is little more than his mother, a lollipop, and serial exam at the local children's hospital just to make absolutely certain nothing changes. The only reason Yuri even made him a trauma alert in the first place is because he technically can't transfer the kid without doing it.
Now, the trauma team is insisting on what amounts to a whole-body CT scan. This is what he gets for playing by the fucking rules
"That's unnecessary radiation, and you fucking know it!" Yuri hisses back at Leo. The kid is fine, anyone with two eyes and a half a brain can tell that. There's absolutely no reason to expose him to the radiation of a CT scan just to prove that beyond a shadow of a doubt.
"It doesn't matter what I know, Yuri. It's what Dr. Altin wants. He's not going to clear him for transfer without it."
"He hasn't even seen the patient!"
"Because he's in the OR!" With the stab wound to the abdomen Yuri sent up forty-five minutes ago. He knows this – he knows all of this – because he and Leo have been through it half a dozen times now. He feels like he's on the world's shittiest carousel. Instead of painted horses, Yuri's riding alternating waves of frustration and rage.
"Look," Yuri begins, steeling himself for round seven. He's so focused on Leo that he barely registers the trauma bay doors opening until he hears Minami shout, "Oh, thank god, there you are!" Although, really, it comes out more like ohthankgodthereyouare. The intern is as white as sterile gauze and holding an EKG in one hand.
"What!" Yuri growls.
"Dr. Giacometti is doing an LP with Guang Hong, and Mickey handed me this EKG!" He shoves the aforementioned EKG in Yuri's direction. It's crumpled from Minami's grip, and the intern is still waving it wildly, and Yuri can't make arrhythmia or ischemia of it. Snatching it from Minami's hands, he smooths out the worst of the wrinkles, and:
"Fuck." Yuri feels his stomach drop. There are ST segment elevations across the EKG's precordial leads with reciprocal depression inferiorly: a fucking anterolateral STEMI. Apparently, a heart attack had been the one thing missing from Yuri's day, and now the universe has so kindly seen fit to rectify that.
"Which room?" Yuri asks Minami, already reaching for his phone to page the interventional cardiologist. Technically, only the attending is supposed to do that, but if Chris is really elbow-deep in a lumbar puncture, then that's not happening anytime soon. This patient needs a cardiac catherization fucking now. The administration can yell at Yuri later, after the patient is in the cath lab getting stents in his coronaries.
"I'm scanning this kid," Leo calls from behind him as Yuri bolts out the trauma bay doors. Yuri is officially out of the precious little time he had for this argument in the first place. Right now, he needs to be at the bedside of the patient having a heart attack, not mired in futile arguments with stubborn surgeons.
"Fine," he shouts over his shoulder. "Maybe you can also resect his cancer in twenty years!"
He doesn't wait long enough to hear Leo's response. His phone is already buzzing with the interventional cardiologist's return phone call. He has aspirin to give and heparin to start and a thousand and one other things to do to ensure that this STEMI patient makes it out of the hospital alive and with decent cardiac function. He can always murder certain surgeons at a later, more convenient date.
It turns out to be not quite the worst shift Yuri's ever had. That distinction still belongs to the shift on Christmas night his second year when he ruined his brand new tiger-print sneakers intubating an upper GI bleed. They'd been a gift from his grandfather, and Yuri had ended up buying himself a new pair just so his grandfather didn't feel like he had to. Grandpa shouldn't have to spend his limited finances just because some old lady took too much Motrin and vomited half her blood volume onto Yuri's feet.
That said, it's probably at least top ten. So the very last thing Yuri wants or needs right now is to run into one of the people that so generously contributed to today's staggeringly high marks on Yuri's personal shittiness scale, which, naturally, means he does.
It's just shy of eight in the evening when Yuri steps out of the hospital into the summer twilight. The sun is technically still up but low enough in the sky that the city skyline has long ago cast the streets into shadow. The oppressive heat of the day has dissipated into a warm evening breeze. In the scattered trees, crickets are already starting to buzz. It promises to be a gorgeous night, marred, in Yuri's opinion, by only one thing.
Otabek Altin is waiting at the curb.
His motorcycle is parked on the side of the street just ahead, and Otabek is currently leaning against it, facing the employee exit that Yuri has just walked out of. At first, he doesn't look up from where he's flicking idly through his phone. Yuri allows himself the faint hope that can still avoid a confrontation. For all his promises of violent homicide earlier, he's exhausted. If he's going to kill someone, he'd rather do it after he's at least had a nap.
Of course, today fucking hates Yuri, so an instant later, Otabek looks up and meets Yuri's gaze.
"I heard you were pretty pissed at me," Otabek says by way of greeting, standing up fully and sliding his cellphone into his back pocket. He doesn't look angry with Yuri, but then he doesn't look anything at all. His face is as inscrutable as ever.
Yuri just grunts in response. He doesn't know what Otabek wants, but if it's to pick a fight, it's going to have to wait. The only three things Yuri's planning to do tonight are get drunk, pet his cat, and pass out on some horizontal surface – probably either his couch or his bed, but he's not willing to rule the floor out entirely.
Except, apparently, Otabek isn't trying to pick a fight. Instead, he reaches around to the back of his bike and, producing his spare helmet, holds it out to Yuri in an echo of the other week. "Here," he says. "Can I make it up to you with a ride home?"
Yuri stares at the proffered helmet, considering. He's still pissed as hell, and he's not sure that a ride home can be considered an even trade for undermining Yuri's medical decision-making and unnecessarily irradiating a child. That being said, he's also exhausted as hell, and the prospect of cutting his commute time in half is almost too good to pass up.
Okay, it actually is too good to pass up. Yuri grabs the helmet. "This doesn't mean I forgive you," he says.
Otabek gives him that tiny little half-smile. "Of course not."
Yuri's fairly certain Otabek drives faster today than he did the last time. They zip around corners at speeds that put Yuri's heart in his throat and his body practically parallel to the pavement. He can't decide whether it's a form of petty revenge against Yuri or that Otabek just figures he doesn't have to take it easy on him now that he's no longer a motorcycle virgin.
That's not the only thing that's different. Tonight, when they arrive outside Yuri's apartment building, Otabek shuts off the bike and dismounts after Yuri. Wordlessly, he stows away Yuri's extra helmet before pulling off and hanging up his own as well.
Yuri crosses his arms, cocks an eyebrow, and waits for Otabek to say whatever it is he so clearly wants to. "I'd like to explain," Otabek says eventually. "If I can. If you'll let me."
Yuri wants to tell him no. He wants to tell him to fuck off and leave Yuri to his cat and his vodka and to take his unnecessary CT scans and shove them so far up his ass that he'll need an upper endoscopy to remove them. What he says instead is: "Sure."
That manages to startle a facial expression out of Otabek. His eyes widen a fraction, and his mouth opens in little O. By Otabek's standards, he looks about as surprised as Yuri feels.
"Wait, wait," says Yuri. He holds up a hand to cut off Otabek's explanation before it can start. Whatever this is going to be, Yuri can guarantee he's too sober for it. "If we're going to do this, you're buying me a drink." He jerks his head toward the bar down the block. "Come on."
It's a Tuesday night and long past what passes for happy hour here, so the bar is nearly empty when they walk in. A trio of men that look to be in their mid-fifties are playing darts, poorly, against the far wall. The only two people at the bar itself are a young couple clearly still dressed from work. They don't seem to be speaking to one another, merely alternating between sipping their drinks and checking their respective phones at twenty second intervals. Yuri's left with the distinct impression of a first date that will never lead to a second.
He chooses a barstool as far from the awkward couple he can get. Otabek takes the seat to his left.
"Vodka coke?" The bartender, Mari, asks as she approaches, because, okay, maybe Yuri does come here too often. Yuri nods. Otabek orders a gin and tonic.
They sit in silence while Mari mixes their drinks. Yuri wonders idly if they too look like they're on an awkward first date and then immediately regrets the thought, because, suddenly, the full implications of what he's just done hit Yuri like 120 joules of electricity to the chest wall. He's just demanded that his staggeringly hot coworker buy him a fucking drink. It's not a date, but it could easily be one, and while, yes, Yuri's still a little furious at Otabek, he also realizes that he actually kind of, sort of wouldn't mind if it was.
He's blushing by the time Mari arrives with their drinks, but in the low light of the bar, he's reasonably certain Otabek can't tell. At least, Yuri's choosing to believe that. He stares resolutely at his vodka coke and waits for whatever Otabek has to say. Otabek, however, seems content to take his time. The silence between them stretches, broken only by country music radio and the occasional cheers from the men playing darts.
They're about halfway done with their drinks before Otabek finally starts talking. "I had a case in fellowship," he begins. Yuri looks up from his drink and meets Otabek's eyes. His face is still neutral, but Yuri almost thinks he sees something in those eyes, something sad. No, that's not it. Something haunted. "He was six years old, almost seven. It wasn't an autoped like tonight. It was an MVC. A rollover. The kid was the backseat passenger, not properly restrained. He seemed fine though. Scared, but fine. I admitted him for observation without any imaging."
He pauses then and takes a long swallow of his gin and tonic before continuing. "Overnight, things got busy. We had more cases going than we really had staff for. The nurse missed a set of vitals, the intern got tied up in the OR, and the kid ended up bleeding out from a splenic lac."
"Shit," Yuri breathes, because he doesn't know what else to say. Those are the nightmare cases. The ones that keep you up at night despite your best efforts to lock the grief away. The ones that challenge your practices and make you second-guess everything you do. The ones that, as a physician, you hope you never have while at the same time knowing that you will. Everyone has them eventually. It's not a question of if, only when.
"It doesn't mean I'm right," Otabek adds. "Scanning all these kids. It's easier – more tangible – to fixate on that one bleed you missed rather than all the kids you're hypothetically giving cancer to in thirty years, but I can't help it. I see his face in every pediatric trauma. I see his parents' faces when I told them their son was gone and because of something we missed. Maybe it makes me coward or a bad doctor or –"
"It doesn't," Yuri interrupts. Just like that his anger has vanished, because: "I get it. I missed a PE once second year." It was Yuri's own nightmare case, his first actually.
The patient had been a young women, just twenty-one-years-old and a college student only a few weeks shy of graduation. She'd come to the emergency department complaining of right flank pain. It was a fairly innocuous chief complaint in someone who was otherwise well-appearing. She'd denied any urinary complaints – dysuria, hematuria, urgency, frequency – but her urine had been positive for both leukocyte esterase and nitrites, so Yuri had treated her as mild pyelonephritis and discharged her home on antibiotics.
She came back eight hours later tachycardic, hypoxic, and hypotensive with a right lower lobe pulmonary embolism on chest CT. She got lytics in the emergency department and spent the next three weeks in the intensive care unit. She left the hospital alive, no thanks to Yuri.
That case had been raked over the coals at the emergency department's morbidity and mortality conference that month. Dr. Feltsman had ranted for nearly an hour on the critical need to consider lower lube pulmonary pathology in the differential for upper abdominal and flank pain. In this patient, he lectured, her borderline tachycardia and history of oral contraceptive use should have been enough to raise the concern for pulmonary embolism.
Afterwards, Yuri had been hyperaware to the point of borderline diagnosable paranoia. "Fucking everyone got a d-dimer after that," he tells Otabek. "For the next six months, if you had pain anywhere between your chin and your belly button, I got a fucking dimer."
Otabek smiles faintly at him over his drink. "I'm sure they were all positive."
"Oh, of course, they were!" Yuri replies, laughing. "And I fucking scanned all of them. For six months! Viktor had to have a full-on intervention on me."
Before him on the bar, his vodka coke is now long since empty. He pokes at the melting ice with his straw. Suddenly, he doesn't feel much like laughing. "I still think about it with every single flank pain, even the most bullshit musculoskeletal stuff. I know – I know – that we have to accept some baseline potential miss rate, or we'd never get anything accomplished, but it still fucking sucks. 'I'm sorry your loved one's dead but don't worry, they only had a 0.1% chance of being dead.' What the fuck does that matter? They're still fucking dead."
He shoves his empty glass forward on the bar and motions to Mari for another round. These aren't conversations Yuri likes having sober. They go better with the fuzz of alcohol wrapped around his brain, dulling the sharp points of emotion that jab eagerly at him as they try to escape the cage Yuri has spent the past several years carefully constructing around them.
Beside him, Otabek takes a final swig of his gin and tonic and then echoes Yuri's motion. "It's a shitty job some days," he concurs. "My father wanted me to be an MBA. Sometimes I think I would have been better off. No six-figure debts, normal human work hours, and a lot less time spent piecing kids' insides back together so they can go get themselves shot again."
Yuri stares at his drink as Mari slides it in front of him. Isn't that the fucking truth. Sometimes Yuri thinks he would do anything to turn back time and take a nice, stable nine-to-five job with weekends and holidays off and where no one fucking dies. There's only one problem with that: "I didn't have a choice. A doctor was the only thing I ever wanted to be."
Otabek's voice is rough as he replies, "Yeah. Me too."
They lapse back into silence then, sipping idly at their drinks. Yuri's beginning to get that warm, floaty sensation that tells him that the alcohol is starting to do its job. Suddenly, he's reminded of exactly how exhausted really he is. At the same time, however, he's surprised to find he isn't ready to go home just yet. It's not just that he enjoys Otabek's company, which he does. It's more than that. Talking to Otabek is strangely cathartic in a way that Yuri is wholly unused to. On any other day like this one, Yuri would have gone home to his empty apartment to stew alone in the day's frustrations. Sitting here with Otabek, however, Yuri finds that those frustrations are gone. He feels lighter than he's ever had after such a grueling shift.
"Anyway," Yuri says eventually, "I guess my point is that you're not the only person running around unnecessarily irradiating people."
He grins at Otabek, who smiles back at him. "So what you're saying is that you forgive me?"
"I suppose," Yuri replies, then adds: "This time."
"In that case I just have one question," Otabek says. He turns on his seat so that he faces Yuri head on. "Are we going to be friends or not?" Otabek's still smiling his tiny little half-smile, but his gaze is more intense than Yuri has ever seen it. It bores into Yuri like an IO gun. Yuri's not sure he believes in souls anymore, but if they do exist, he can't help but feel like Otabek is looking directly into his. He hopes Otabek likes what he sees.
"Yeah, sure" Yuri croaks, feeling slightly overwhelmed. "Friends."
Otabek exhales deeply, and only then does Yuri realize that he'd been holding his breath. Yuri can't fathom why. Was Yuri's response really that important to him? Otabek is a smoking hot trauma surgeon who rides a fucking motorcycle. Why would Yuri's, of all people's, friendship ever matter to him?
"Friends," Otabek echoes, holding out his hand to Yuri. Yuri takes it. Otabek's grip is firm and warm, and Yuri's palm tingles with the contact. Yuri doesn't want to let go.
"Don't think this means I won't call you out on your shit, though."
Otabek laughs at that, actually really laughs. It catches Yuri off guard, partially because he's never heard it before and partially because it makes his insides go warm in the strangest way. He feels as though someone has just dumped warmed saline into his stomach.
"I wouldn't have it any other way," Otabek says. He's still holding on to his hand.
By the time their second round of drinks is gone, Yuri can no longer ignore the fact that he's rapidly approaching being asleep on his feet. Mari brings their check, and Otabek tosses enough cash onto the bar to cover all four of their drinks. Yuri protests that he doesn't have to. The deal had been a drink, after all. Technically, he should be paying for his second.
"Don't worry about it," says Otabek, sliding off his barstool. "You can get me next time."
Yuri feels his heart flip at that. Next time.