Chicago Med fic: Suckerpunched (1/10)
Dec. 23rd, 2021 04:48 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
faye_dartmouthTitle: Suckerpunched
Disclaimer: I own nothing here.
A/N: Set post S6, but written before ever seeing anything in S7. Therefore, I guess this is technically AU at this point. Don’t mind the supreme overuse of medical nonsense. If you’re someone who craves accuracy in all things, don’t keep reading. I am fast and loose with the medical side of things, and I make no apologies. Fill unconsciousness square for![[livejournal.com profile]](https://www.dreamwidth.org/img/external/lj-community.gif)
hc_bingo. Very, very unbeta’ed.
Summary: He lost control, for a second, just for a second, and it wasn’t supposed to happen. One punch -- the most unlucky damn punch in the entire world.
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
The truth be told, Archer hadn’t come to Chicago Med looking to take over. No, Archer was at his core a very pragmatic individual. When his old position had been eliminated, he’d realized very quickly just how limited his options were. He was a damn good surgeon, but the country was full of good surgeons. At his age, and with his limited background at a smaller hospital and army postings, he just wasn’t going to be a big-draw hire.
His options consisted mostly of other small-time hospitals or, worse, clinics, where he’d be lucky to get a comparable attending position. At his age, this would feel like a setback, but he’d resigned himself to that inevitability because the only other option was early retirement.
Early retirement would be a death sentence, and he knew it. He had enough trouble being alone inside his own head, and to face that without a job? Without purpose?
That wasn’t going to end well.
He’d been preparing to send out his resumes when he got the call about the Med job, and he probably would have taken it no matter what, but then he’d found out that the position was with Ethan and he’d thought, slam dunk, no brainer, he’d hit the jackpot.
Of course, when he got here, he realized it wasn’t with Ethan, but for Ethan, and that for all that Chicago Med was touted as the best in the state, it was still staffed with half-assed dimwits who were more distracted by their personal drama than patient care. The pithy nurses who made all sorts of assumptions. The brazen charge nurse who thought she was all that but spent more time fussing about her family.
And the doctors.
The damn doctors in that place. Difficult and whiny. They were busy hooking up or running inane drugs trials. Even Ethan, who he himself had trained, had fallen victim to him. It was disheartening that he was just as bad as the rest of them.
Considering this, getting named head of the ED was a stroke of absolute luck.
His luck, of course, given that Ethan had been trying to fire him.
And theirs. This ED had no idea how much they needed someone like him to get things whipped into shape. It was a coincidence he wasn’t going to take lightly, especially since he knew that his window of opportunity was scant. Ethan’s recovery timeline was long, but not that long. If Archer was going to clean house, he had to get to work and stay focused.
Ethan would thank him for it.
Goodwin might just promote him for real.
He had already managed a few nurses, getting a few less savory figures transferred, and he got one to up and quit. April had put in her notice, so he didn’t have to worry about her for much longer, but the doctors were a harder sell. He had scared a few of the residents into playing to his own strengths, and it was fairly easy to take control of the med students to set the tone to his liking. The attending were more annoying, however. They were just too set in their ways, and they thought they knew what they were doing.
They didn’t.
Sure, they manage to save some lives, but they could be so much better. Archer was just going to have to get a few of them to realize their fortunes were better elsewhere. Firing them would be hard, it seemed, but getting them to quit?
Well, Archer might be able to do that.
All he had to do was set standards.
And watch them fail,
Starting, naturally, with the weakest link of all, Dr. Will Halstead.
Halstead was inexplicably popular in the ED. Despite the fact that Archer was in charge, people seemed to go to Halstead first for his opinion and support. The guy had literally no standing, but people always wanted to know what he thought.
The stupidest part was that Halstead’s judgment was 100 percent suspect. The guy had openly botched his own clinical trial. For his ex girlfriend, no less. He nearly killed her mother, blew up the career of his current love interest, who was way out his league, by the way, and still lost the girl anyway.
Oh, and the asshole had been fired.
Kicked out on his ass.
Archer wished he could have seen it, and he couldn’t conceive why Goodwin had hired him back. The fact that Halstead hadn’t stolen the drugs in first place seemed like splitting hairs. The guy was clearly a disaster who had no place in a well functioning ED. Goodwin must have been feeling sentimental that day, and now Archer had to live with the aftermath.
Because they did love Halstead. Maggie gave him the best cases. Crockett preferred his second opinion. The nurses wanted to be assigned to his patients. The residents went to him for help. Attendings sought him out to commiserate.
It was ridiculous. It was stupid. It was annoying.
It was flat out untenable.
This was Archer’s ED for now. He needed to take charge of it now -- before he was out of time to make his mark indelible.
He had a whole list of possible changes to make, some of which he’d already begun implementing on a micro level. But he was running into resistance from the staff, and he just needed one domino to fall to get them in line. As best he could tell, Halstead was the ideal domino. Influential with the staff but precarious with the administration, Halstead had the connections to make him a prime candidate.
Plus, Archer just didn’t like the guy.
He was inconsistent -- brilliant one minute and an idiot the next -- and it was all about emotions. He was swayed by all the wrong things, and he just wasn’t that interesting as he slept around the ED and made obvious bad choices for sentimental reasons. They were all there to save people, but Archer had the common sense not to walk around like a self righteous, red headed moron.
On top of all that, Halstead had made himself an easy target. After getting fired, Goodwin had been convinced to offer him back his job -- but it was clearly a pity play. Ethan was out for awhile, and with Manning gone, she probably felt emotionally strained at the idea of losing another long-serving member of the staff. She was a smart woman, but even she was prone to sentimental failings from time to time.
That said, Halstead was obviously on the thinnest ice available. He had a job, but he was strictly on probation. One wrong move, and Goodwin wouldn’t even need to think about it.
All Archer had to do was amplify that move -- make sure it happened.
In short, if he pushed the right buttons, Halstead would all but fire himself, the predictable, self righteous asshole that he was.
Archer had been looking for his opening for a few days now.
And today, Halstead handing him the opening he wanted on a silver platter.
It was his patient.
A woman with terminal cancer -- check.
A patient with an ironclad DNR -- check.
Halstead in charge -- check.
DNR magically averted and extraordinary measures applied -- check.
The final checklist that Archer needed to seal Halstead’s fate.
Sure, there were copious notes in the file explaining the extenuating circumstances, but still. Still. Halstead had a history of going off-book and disregarding medical ethics. His judgment here was inevitably and intracvertibly suspect. Everyone knew it. Hell, Archer hadn’t even been here for most of the indiscretions, but they still lived on in ED infamy.
Now, all Archer had to do was get Halstead to own to it.
Technically, that wasn’t necessary -- Archer would raise the concern with Goodwin either way -- but it sure was fun to needle Halstead. Something about his smug face just invited it, as far as Archer was concerned.
With this in mind, Archer cornered Halstead in the doctor’s lounge. The guy was getting a cup of coffee, and no one else was around. Archer went inside, pretended to wait his turn at the pot, and started up the talk.
“Long day?” Archer asked, making a slim attempt to be coy.
Halstead nodded with a slight hum.
“I mean, filling up on coffee at, what? 2 PM?” Archer pressed.
Halstead had his cup and was stepping out of the way for Archer to get his. It was a gesture that Archer ignored, even while Halstead stirred creamer into his cup.
“All the days are long,” Halstead said. “I worked an extra shift last night.”
“Right,” Archer said. “Still trying to prove yourself, right? Get in good with the boss?”
Halstead gave him a bland, uncommitted smile. “Just trying to pitch in.”
Archer still didn’t bother with coffee, watching as Halstead went over to the table and sat down. He took a sip while getting out his phone, and Archer narrowed his eyes at him willfully. “I figured it was probably about the case you pulled this morning,” he said.
Halstead looked at him, face not registering much surprise.
“The DNR case,” Archer said, leaned back on the counter as though this were benign small talk. “A mother with small kids. Cancer.”
Halstead stiffened a little, as if he noticed for the first time that this line of querying wasn’t innocent. “It was all pretty by the book,” he said. “I made sure to put it in my notes.”
Archer nodded but made a face. “But you do have a history of these cases--”
Will put his coffee down and drew a breath that seemed to be an effort of self control. “Cases I learned from,” he said. “There were no mistakes in this one.”
“No mistakes,” he repeated, nose wrinkled a little more now. “You just magically convinced your terminal cancer patient to reverse her DNR within one hour of knowing her?”
Will nearly abandoned his coffee now, getting up instead. “The circumstances were extenuating,” he said. “She was in for a car crash; her cancer treatments are working well to give her a sustainable quality of life. The DNR was for her end stage cancer treatment, not accidents. Her family agreed. She signed off on it. Dr. Charles consulted. Two nurses witnessed everything. There’s nothing magical about it.”
It was a lengthy defense.
The truth was often a lot simpler.
Archer pursed his lips. “Um, great. So all I’m hearing is that you changed a patient’s DNR status but were smart enough to cover your tracks this time,”
Will scowled, picking up the coffee cup and dumping the remains in the sink before leaving the cup to be washed. “You have the chart right in front of you, so you know that’s not what happened,” he said, moving around Archer to throw his napkin in the trash. “And you can talk to the patient’s family -- there are no objections, no accusations of anything. Also, for what it’s worth, the patient is expected to fully recover.”
“All the same, given your, uh, history, we should get this case reviewed by Goodwin,” Archer said with an innocent shrug.
Halstead just shook his head, making no attempt to rise to the bait. “You know what?,” he said, brushing by Archer to the door now. “Be my guest.”
Archer had his opening. There was no way in hell he was letting it slip by. He squared his shoulders, planted his feet and shoved his hands in the pockets of his coat. “Do you have a problem with me, Dr. Halstead?”
Will turned. His expression was somehow incredulous. “Do you have a problem with me, Dr. Archer? Because you seem set on second guessing everything I do.”
Archer at least had cause to be incredulous. “Of course I am. As you were fired for major indiscretions, I think some extra scrutiny is absolutely valid,” he said, his tone cutting. “In fact, I think I would be remiss as the head of this ED if I didn’t watch everything you do.”
It wasn’t meant to be a low blow as much as a direct hit. Archer wasn’t one for nuance. He preferred to go after things with the finesse of a tank, and playing nice wasn’t his style. He wasn’t sure where Ethan learned diplomacy. But it clearly was not from him.
To Halstead’s credit, the blow didn’t make him fold. He turned, squaring up his stance as well, ready to fight, just like Archer had intended.
“I was fired, but then I was reinstated -- and cleared for duty by Ms. Goodwin herself,” he returned, yielding nothing. He lifted his chin in a telltale sign of defiance. “If you don’t trust my professional opinion, then I’m not sure how this works, because she does.”
“Oh, your professional opinion?” Archer said with a caustic laugh. “Is that the professional opinion that tanked an entire trial for a woman who didn’t even love you anymore or the one that nearly left Dr. Choi an invalid?”
Now, that one was a bit of a low blow. If he wanted Halstead to take the bait, he had to make it enticing. The look on his face bordered on contempt now, so Archer felt like he was probably on a viable track.
“You have no idea what you’re talking about with Dr. Manning, and you got lucky with Ethan and everyone in the ED knows it,” he said, and his voice was hard now.
But if Halstead thought he was winning this fight, then he was truly as dumb as he looked. He stepped forward, and he didn’t have to sneer. Condescension would work just fine on Halstead’s already damaged ego. “It’s called intuition,” he said. “I have it, and let’s face it. You don’t.”
It was a good shot, but somehow, this time it missed. Halstead let the tension drain from his shoulders, and he eased back in his posture. “The good news is that none of this matters. Ethan will be back soon,” he said,and his lips almost returned up into a smile. “Then you will just go back to being that annoying, bitter colleague that everyone hates but is just too nice to tell that to.”
Condescension was effective, you had to give the asshole that. Halstead hadn’t taken the bait, and Archer felt his own ire rise.
Who was this guy?
What kind of right did he have here, to talk to Archer like that?
How the hell did someone like Halstead still have a job?
Why had no one wiped that dumb look off his dumb red head?
Halstead looked pleased with his comeback, and the little prick turned to leave, as if that were that.
That wasn’t that.
There was no way.
Archer was older, wiser, smarter, better. Someone needed to teach Halstead a lesson, and if Archer accomplished nothing else, then this would be his legacy, so help him God.
Fingers curled, breath baited, Archer wasn’t conscious of his next choice even as he was already making it. Patience, impulse control, whatever.
“Halstead,” he said, drawing the other man back around.
And before he knew it, before Archer knew it, his fist was flying through the air, aimed directly at the stupid, smug look on Halstead’s face.
The punch caught Halstead on the temple, and it was harder than Archer had intended to throw. He lost track of stuff like that, sometimes. He couldn’t always tell the difference between a little and a lot. Nuance was not particularly his strong suit. It was right up there with patience and self control as things.
That said, there was no denying it was a lucky punch. Halstead went down immediately, spun by the force of the blow he hadn’t seen coming. The suckerpuch had blindsided him completely; it was likely that he didn’t even have a clue what had hit him.
His backward trajectory was unstilted, and as he fell, he hit hard against the counter. The thwack was sickening, and Halstead’s descent to the floor was harder still. He landed without protecting himself from the fall, and his head rebounded once before he settled, sprawled and still, on the lounge floor.
It happened fast. Within a second, Halstead was up and smirking and then down and out. Archer’s fist ached, and he felt a momentary flicker of satisfaction. He’d been wanting to lay Halstead out for three weeks now.
The satisfaction was short-lived.
Because he hadn’t just laid Halstead out.
He’d knocked him out entirely. As a doctor, Archer had seen a range of unconsciousness. As a man with a temper, he’d been in his share of fights. A simple punch to the head could make you black out and wake up with a headache and some shame. A punch like that? With two secondary hits?
Well, people got concussions from things like that.
And Halstead wasn’t moving. Not as much as a twitch.
As an army surgeon, he was trained to make split-second assessments. Those quick-thinking diagnoses had saved countless lives in the field. It was one of the things he was well and truly good at. His first instinct was usually the right one.
Halstead had more than a concussion.
No, Archer had knocked him senseless.
Punches like that, hits like that, falls like that -- people turned into vegetables from injuries of that caliber. Sometimes, they died. Sometimes, you just wish they had.
Archer had wanted to punch the smug look off Halstead’s face, but kill him? Archer hadn’t been thinking when he threw the punch, but he was thinking now. He was thinking about the fact that he’d just lost his self control -- again -- and put the life of one of his colleagues at risk -- again. Ethan had survived. Halstead--
All his character flaws aside, Archer was still a doctor. Springing back into action, his adrenaline kicked in. Crossing quickly, Archer dropped to his knees, quickly pressing two fingers to Halstead’s neck. He had a pulse.
He bent down, close enough to hear Halstead’s heart. Fast and thready. Breath sounds were barely discernible. He wasn’t moving enough air.
Sitting back up, he quickly took his penlight out of his pocket. Swiftly, he opened Halstead’s eyelids one at a time, but there was no pupillary reflex. With a field neuro exam, Halstead failed on every count. He had a GCS of 3.
There were half a dozen things that could account for this, some of them relatively benign. But Archer knew. One lucky punch, and now Halstead was hemorrhaging. Half of patients with a brain bleed didn’t even make it to the hospital. Halstead had the odds skewed in his favor since he was already here, but only marginally so. Even with prompt treatment, another 30 percent of patients died. Of those who survive, up to 40 percent could be left with permanent deficits ranging from mild to severe.
That wasn’t a lucky punch.
That was the most unlucky punch in the world.
Which meant Archer needed to act.
Now.
All of Archer’s weaknesses, you couldn’t say he was bad in a trauma. Moving quickly, he got to his feet, getting to the door in a few wide steps. He opened it without hesitating, calling out to whoever happened to be closest. “Quick, I need a backboard -- now,” he said.
Naturally, yelling for a backboard in an ED wasn’t exactly unheard of, but there was a process for these things. Most of the time, acute injury happened outside the hospital. People got lazy with the paramedics doing the triage for them. It deadened their response times during actual conflict. Most of these ED employees would fall to pieces in an actual warzone.
It was still a point that drove Archer crazy.
It was also a point that might cost Halstead precious minutes.
“A backboard!” he yelled again. “Now!
Most people just looked dumbfounded. Maggie, who was the one person he might expect to be on top of things, was the only one with the wherewithal to approach.
Just approach, mind you. She looked confused at his request, holding that damn phone of hers like some idiotic lifeline.
She acted like the whole world could be controlled there. She had gotten softer than any of the rest of them. Honestly, Archer wasn’t sure she was fit for these trenches anymore. “What?”
He didn’t have time to baby her. More to the point, Halstead didn’t have time. His brain cells were probably dying as she gawked, and Halstead couldn’t afford to lose many. “It’s Halstead,” he said flatly. “He's hurt.”
Simple English, straightforward language, and she looked more confused. “He’s what?”
Halstead wouldn’t stand a chance with her. Maybe he should have tried to get a new charge nurse instead of fixating on Halstead. Rolling his eyes, he crossed in front of her to one of the supply stations to retrieve it himself.
By the time he made it back to the lounge, Maggie had already entered ahead of him. She stopped short and made a strangled sort of noise in her throat. Archer pushed by her brusquely, and Maggie fell into step before going to her knees next to Halstead’s prone figure, still and spread-eagle on the floor. “What happened?”
The lack of professionalism from her was appalling. Everyone loved Maggie, but Archer didn’t see it. A new charge nurse was definitely in order. She had been given too much latitude for far too long.
“He hit his head,” Archer explained in the simplest terms possible so she could keep up. He positioned the board himself, bringing it alongside Halstead, when she seemed too shell shocked to participate. “Hard.”
Gently, with years of practice honed on the battlefield, Archer reached down and supported Halstead’s neck while rolling him to the side with his other hand. There was a smear of blood on the floor, and more of it was matting Halstead’s hair on the back of his head. Finally, Maggie remembered that she was a trained nurse and had the wherewithal to help. She grabbed the board, sliding it into place while Archer eased Halstead down. He continued supporting his c-spine, and Maggie started strapping him down.
When he was secure, Archer moved to the head to lift him, thankful that Maggie at least had the presence of mind to pick up the backboard at Halstead’s feet. He was heavier than he looked -- the bastard was a tall son of a bitch -- and Archer hoisted him between the two of them, hoping that Maggie wouldn’t be stupid enough to drop him.
That would be the last thing Halstead needed -- another head injury. Archer intended to make sure the guy still had a few of his scant brain cells left after this debacle.
It wasn’t easy opening the door and navigating the backboard out into the hallway, but Maggie was actually ahead of him on this. With the door open, she called out quickly. “April, Doris! We need a hand here!”
The two nurses came rushing over -- along with the rest of the ED. For some reason, Halstead remained impossibly popular with the staff, and the ED had the trappings of a high school with its penchant for gossip and hookups. Archer knew this rubbernecking, therefore, was inevitable, but it made the situation a touch more uncomfortable. He had wanted this altercation to be more of a private matter. This publicity wasn’t part of the plan.
And okay, the head injury wasn’t part of the plan, either.
Things were going a little off course for Archer today -- and all the other days. Life after the military had not been particularly easy for him, and this kind of crap, right here, was why.
“What’s open?” he asked, face set taut as he dared the rest of the ED to come any closer. “Maggie?”
“Uh--” she said, faltering.
“Baghdad,” April blurted. “They just finished prepping Baghdad.”
Normally, Archer might consider that overkill, but he was dealing with a suspected brain hemorrhage, and time was short, so he wasn’t going to dicker about the details.
“Okay,” he said, shifting his direction to move to the main trauma bay. “Get in there -- I want him on an IV and monitors.”
April and Doris scurried ahead of them, and Archer barked to the rest of the ED with a glare.
“Back to work!” he said. “This isn’t a sideshow! We still have work to do!”
It was an unsympathetic tact, but it was the only reasonable option. They did have an ED to operate, and sentimental pandering wasn’t going to help. Halstead needed a normal trauma team, not half the ED sobbing over him. He doubted Halstead would want it anyway.
And if it happened to buy Archer a little time to figure out how to explain this situation?
All the better.
The trip to Baghdad wasn’t terribly long, but Halstead’s dead weight felt more pronounced than necessary. He banged through the doors with all due haste, directing the backboard to the gurney. Maggie helped him steady it, and soon they had it deposited on the gurney, Halstead still unconscious and strapped down.
Despite invoking Doris and April to help out, Archer was still the only one doing anything. He turned the trauma lights on, pulling the trays nearby and ripping the protective packaging clear. Under the harsh lights, the bruise on Halstead’s temple was starting to blossom, and the milky color of his skin took on a nearly translucent hue.
“Come on, people,” Archer chided. “We need to get him set up on the monitors -- I want vitals!”
April had come up on the other side of Halstead’s gurney, and Doris seemed to be at one of the carts. He wasn’t sure what the hell Maggie was doing at this point, and he was well aware that his earlier order to get back to work was being ignored by mostly everybody. The room had already collected a small gallery, and Archer caught a glimpse of more people just outside.
Which was perfect.
Archer totally needed an audience for this.
He glared at Halstead. The guy couldn’t even take a punch without being difficult.
This was really turning out to be a long, miserable sort of day -- and Archer wasn’t even the one with a head injury. His head pounded like he might have one, but no. That was just the incessant stress of being alive and living among idiots.
Somehow, April had only managed to get the pulse ox monitor on. He wasn’t sure what the hell Doris was doing, and Maggie looked like she was crying. Halstead, looking worse by the minute, was clearly tanking -- and in a fit of frustration to get this trauma moving, Archer cut Halstead’s scrubs clear and grabbed the IV kit himself. He half pushed Doris out of the way, unfolding one of Halstead’s arm to get better access to the veins.
“Can I get a tourniquet?” he asked, but no one was listening. April had managed to hook up a few of the leads on the chest, and Archer rolled his eyes, sloppily tying off Halstead’s bicep in an attempt to speed up the process of starting the IV.
Starting an IV was an annoying process, and admittedly, Archer hadn’t had to do one on his own in years. He could feel himself start to sweat. He stole another glare at Halstead, still out cold on the gurney. How did this asshole get the easy job here?
He missed the vein the first time, and his jaw locked. Self conscious, he cast a glare in the direction of the crowd.
“Didn’t I tell everyone to get back to work?” he said, voice cutting and caustic. “There is still such a thing as patient privacy, and Halstead’s rights don’t go out the window just because he happens to be on staff.”
He got the vein with this second attempt, and he pulled the needle back, testing the flow. April seemed to have the leads running, and Doris had come to her senses enough to start turning the monitors live.
“If you won’t do it for Halstead, do it for yourself,” Archer snapped, his patient thoroughly spent now. “Anyone still in here in the next five seconds will be fired. Now go.”
He must have sounded pissed -- and he was -- because the crowd slowly disperse with a few stragglers leaning back. Archer glanced up at them, eyes locking on Maggie, who hadn’t moved from her spot at the end of Halstead’s gurney.
She had proven herself utterly useless. “You, too,” he ordered her with a terse nod. “I only need April and Doris. More people than that, and it’s just going to be a distraction -- and Halstead can’t afford any of those, so I suggest you get the hell out unless you would like to compromise his critical care.”
Maggie’s breathing clearly caught, her chest hitching as she showed extreme reluctance to comply. Archer didn’t yield, though, and playing the critical care card was a convenient guilt trip.
And a real one.
Halstead really did look bad.
Archer figured Halstead was selling the urgency here as much as he was, because with one last look, Maggie turned and left, taking the last of the gallery with her.
With them gone, Archer hung the IV, attaching a liter of saline and starting the drip wide open. On the other side of the gurney, April had finally finished getting the leads set up, and Doris had the monitors fully operational as the first round of vitals came rolling in.
“BP is low -- and dropping,” April said with a tight inhale. “His heart rate is inconsistent and thready.”
April was keeping it together, if only just. Doris wasn’t doing quite as well.
“O2 levels are at 75,” she said. A muscle tightened in her jaw. “And also dropping. Fast.”
“He’s barely moving air,” Archer said, noting to himself that this was consistent with his working diagnosis. No doubt, Halstead had diminished brain function with the building pressure in his skull. Their window to address it before the damage was permanent was closing fast. “We need to intubate now. Someone get me prepped. A milligram of ectomodine and another of sux.”
He watched as Doris grappled for the drugs, her fingers trembling as she reached for the line.
Archer busied himself back with Halstead. For good measure, he checked his reflexes once more, but he didn’t respond. Even with knuckles to the sternum, Halstead remained utterly limp.
Doris, finishing with the second injection into the IV, was beside herself. “He’s got a GCS of three, doesn’t he?”
Because panic was exactly what Archer needed right now. It defied all common sense how Ethan had operated this ED; at this point, Archer wasn’t even sure it was salvageable. He just wanted to fire them all and start over -- for all their sakes. “We have to keep focused, please,” he said, grinding out the words in an attempt to make his point and not ball his fist once more.
He usually liked Doris, who knew how to ruffle feathers, but this trauma was showing her limitations. “But what happened?” she asked.
Everyone had a thousand questions, but Archer had a singular focus. If he was right -- and he had no doubt that he was right -- Halstead was currently bleeding in his skull. There was no time to waste on questions or explanations.
“Look, we were fighting, okay?” he snapped. “Words were spoken, punches were thrown. Now where is the damn ET tube so I can get some oxygen in him?”
April produced one, but she still looked shellshocked as she handed it over. “Words? Punches?” she said. “I don’t understand. Will was totally fine today.”
“Well, he’s not fine now,” Archer muttered, tipping Halstead’s head back and looking for his angle in order to visualize the vocal cords. “Did someone push the etomidate and sux?”
“Already on board,” Doris reported, adjusting the IV that had been hung hastily.
Archer shook his head, because there was no change in Halstead. “He wasn’t protecting his airway at all anyway,” he said, starting to slide the tube in. There was no resistance, and he felt it all the way down, until the end was properly situated in the airway. “Okay, someone start bagging him.”
April at least had that down. She hooked up the bag quickly and started ventilating with efficient, clean motions. While his chest inflated dramatically, Archer took a stethoscope and placed it over the lungs, waiting to hear the telltale signs of proper function.
“Placement’s good,” he reported, checking both sides of the chest. “Breath sounds are equal.”
April turned a keen eye to the monitor. “O2 levels are rising. Back to 88 and climbing fast.”
“Good,” Archer said. He eyed the monitors again. “BP has risen slightly with the fluids, but it’s not as stable as I’d like.”
“It still doesn’t make sense,” April said, keeping the bag steady over Will’s lax features. “What were you even fighting about?”
The question grated against Archer’s very last nerves; he did his absolute best to ignore it. “Can one of you do a blood draw?” he asked. “I need to run a full metabolic panel, and let’s type and cross, just to be safe.”
“It’s really not like him, is it?” Doris said, the question directed more at April than Archer as she reached for a blood kit. “I know he’s impulsive, but I’ve never seen him throw a punch -- not one -- even when someone deserved it. This whole thing -- it’s not like him.”
“Apparently it is,” he muttered, but the condescension was cut short as he looked at the monitors again. Halstead had stabilized his oxygen levels, but the rest of his vitals suggested that the complications were just starting. The BP was starting to tank again; the fluids weren’t going to be enough. “And we don’t have time for this--“
As if to prove his point, Halstead went rigid a split second before his legs started trembling. Within seconds, his entire body was jerking. Normally, Archer would welcome the unexpected backup from Halstead, but the asshole really knew how to pick his moments.
“Damn it,” he hissed, already going through his revised diagnostic protocol. The seizure didn’t change his working theory. Instead, it solidified it. Halstead’s condition was getting worse.
Everyone else in the room was two steps behind him.
“Head injury?” April asked. She sounded concerned. “They happen with concussions.”
“Yeah, and with brain bleeds,” he added tersely.
April’s concern ramped up instantly. She spoke in alarm because for some reason, she hadn’t posited the most likely conclusion here. “You think--“
His patience thin and Halstead still trembling unabated, Archer reached for the drugs himself, pushing aside vials that clanked noisily on the cart until his fingers locked on the right one. “I don’t think, I know,” he corrected her. He handed the vial to Doris, who was closest to the IV. “Give me 5 milligrams, and let’s hope it makes a dent.”
Still wide eyed, Doris was just bright enough to know what to do without being too bright to question him. It was how Archer liked his nurses: competent but without much independence.
April, on the other hand, was beginning to piss him off as much as Halstead. It was a good thing she was leaving, or Archer would have to reckon with that sooner or later.
April persisted, bless her heart. Loyalty to an undeserving recipient in Halstead, an overly inflated sense of ego, whatever the case may be. “But it could be a concussion, skull fracture--“
He watched Doris administer the drugs, keeping Halstead on the edge of his vision. He counted the seconds in his head, calculating the odds of brain damage based on the length and severity of the seizure.
“Or a hemorrhage, just like I said,” Archer said. At that moment, the tremors started abating. Within another few seconds, Halstead went limp again with his limbs lax and his head tilted just to the side. The only sign of life was coming from the manual ventilations through the tube in his throat. The seizure was over at least, but the fight for the asshole’s life was far from over. “Doris was right. His GCS is three. He is completely unresponsive, and we’re having trouble keeping his vitals up. We could play the odds, see if it’s just a concussion, all while we let his brain die and he ends up in a vegetative state or worse.”
Archer didn’t need to raise his voice or get in their faces to make his point dominant.
No, he just needed the facts.
And the guts to make the perspective clear when everyone else was busy playing Little Miss Sunshine.
“Or,” Archer posited now that he had their attention. “We could treat him aggressively and save whatever may be left of his brain. So, I want to get him up to CT--”
He had thought he’d made his point, but April was like a bad song stuck on repeat. “It’s backed up--” she started, still pressing air into Halstead’s lungs.
Exasperation didn’t describe his emotions any longer. They had long since past that, and Halstead’s vitals were only going to continue to decline. The fluids and meds bought them some time, but not much.
Probably not enough.
“Then unback it up, cut it line, I don’t care,” he said, marking off the critical to do lis5 in his head. “Get his blood drawn and off to the lab, and make sure they know it’s a rush job. I want results in 15 minutes. Then, someone go grab Abrams and tell him he’s got a case--”
Doris was drawing the blood from Halstead’s other arm, filling up two vials and capping them. She looked at Archer with concern. “Abrams has been unavailable for hours. He’s in surgery--”
Doris probably thought, in some idiotic misguided way, that she was providing keen insight here, but all Archer heard was excuses that would let Halstead’s limited braincells continue to die in dramatic and unabated fashion. “Yeah, not as pressing as this one.”
Doris was putting stickers on the vials for purposes of identification. “But it’s against protocol,” she said, and no doubt, she only knew this because it was a protocol she’d run up against before. “And he hates it.”
Archer’s frustration was rapidly reaching a breaking point, but a loss of control here would be catastrophic -- for Halstead as much as himself. “I don’t care about Dr. Abrams’ delicate feelings, and protocol will leave Halstead dead,” he said. He tipped his head to the side, gesturing to their patient. “Is that what either of you want right now?”
The pair of nurses -- Chicago Med’s best, God help him -- said nothing, looking at Halstead instead. Archer had a good point, but Halstead made it vividly clear with his pasty skin and the tube down his throat. Since they seemed to like the guy, the fact that he was currently dying was probably going to be enough of a convincing factor.
“But there are protocols in place to call the neuro resident on call,” Doris said, continuing to press on the same stupid tact as before.
And really, it was an inane thing to say. Beyond inane, really. Archer didn’t have the time -- Halstead didn’t have the time. “That’s great, but I’m sure Dr. Halstead here would like not to be brain dead,” he said pointedly. He slowed down his enunciation to mark his point. “Get Abrams.”
“Even if I thought he would do it, we don’t have standing,” April pointed out, with a nod to Doris. “You need to get him out of surgery, do a consult without all the scans--”
Archer sighed, feeling the pressure mount behind his eyes. This day was really getting on his nerves. “Fine, I’ll get Abrams myself,” he said. He pointed to Halstead on the gurney. “You two focus on getting him up to CT -- he’s already prepped, so all you have to do is clear the line, any way you can,” he said, directing his hand to the hallway beyond. “Don’t wait for the results. Transfer Halstead to the OR immediately.”
“But the scans will be needed to confirm the diagnosis,” Doris said.
“And the scans will be loaded within minutes,” Archer said. “I expect to have them in his file by the time I get Abrams out of his OR. Give him a minute to consult, and Halstead’s already prepped in the OR by the time Abrams scrubs in.”
“But what if we can’t clear the line?” April asked, brow furrowed deeply. “What if we can’t secure the OR?”
“Then, say your goodbyes now, because Halstead’s not coming back,” he said, with all the harshness he intended. He gestured to Halstead’s unmoving form once more, letting the tube down his throat and the unnatural stillness of his body prove the point for him.
Doris looked like she was ready to cry again, but April’s face hardened with distaste.
Archer shrugged. They didn’t have to like him. They just had to fall in line. “I’ll leave it to you to decide,” he said. “If you care at all about giving Dr. Halstead a chance, you will do exactly as I say.”
They looked scared, out of their depth, whatever, but he was going to trust them to be professionals for the moment.
It was a tall ask, and given what he knew of this ED, it wasn’t a given. But, Archer had to hope, with their beloved Dr. Halstead at stake, maybe they’d step up their game.
For Halstead’s sake, Archer was reduced to hope.
“Good. Now we can skip the idiocy and start making an actual plan to treat him,” Archer said, making the seamless transition. “Get him up to CT, but stay with him every second. I want him fully oxygenated at all times, and if there is any change in his rhythm, I want to know immediately. Once the scan is run, do not wait for further authorization. Have him set up in any available OR, and prep him yourself if you have to while I get Dr. Abrams on board. In 20 minutes, I want Halstead open on that table, do you understand?”
Doris looked sufficiently cowed, but April drew her lips into a line. Even after everything, she still had to have her say. Ethan must have found that rebellious streak attractive, but Archer no longer fathomed the appeal. “20 minutes is still nearly impossible,” she said, continuing to squeeze the oxygen bag.
“And as far as Halstead is concerned, it’s too much time,” Archer said. “If I’m right -- and I know I am -- the CT will show a massive bleed in his brain. If I had my way, I’d skip the CT and just open him up right here and now. But we have to play by some rules -- even if I fully intend on breaking all the rest. If either of you have a problem with that, the door is right there.”
He pointed to the door, and it wasn’t so much a bluff as an offer he knew they wouldn’t take. They could be dense, they could be stupid, they could be stymied by their own limitations -- but they were still nurses, and they still cared about patients -- and they still cared about Halstead. Neither of them had a plan, and Archer did. That was all that was needed right now.
Too many people thought that leaders had to be better or smarter than everyone else. That was all just nonse. Leaders just had to take initiative in a vacuum and wait for everyone else to fall in line, just like they always did.
Doris nodded. April nodded.
And Archer nodded back. “Good,” he said. “20 minutes. I’ll see you there.”
-o-
Sweeping out of the exam room was a dramatic turn, but Archer couldn’t deny that he was starting to feel a little anxious about this plan. No one questioned him as he charged out of the ED, going for the stairs and taking them two at a time up to the surgical floor. Archer had sway over nurses -- this much was true -- but Abrams was going to be a different animal.
Assuming Archer could ramrod Halstead through CT. Assuming the surgical staff accepted his insistence that they prep an OR without proper documentation. Assuming Halstead didn’t die on the way.
Assuming all that, Abrams was still going to be a pain in Archer’s ass.
No doubt, Abrams was one of the better doctors in this hospital, though Archer didn’t think that was an especially difficult task as he had met most of the doctors here. Still, Abrams knew his own value a little too well, and it made him a prick more often than not. He didn’t have much of a stomach for pretentious assholes, which was why he only subjected himself to Abrams’ insufferable demeanor when absolutely necessary.
Unfortunately, it was necessary now, and Archer was too aware that he was coming at this from a deficit. He preferred a position of power when asking for favors, but the fact was, he didn’t have one. He could only appeal to Abrams’ vanity and the slim possibility that he also harbored some ridiculous fondness for Halstead. If not fondness, then some modicum of respect.
That was asking a lot -- because Archer knew Halstead -- but still. The social dynamic in this place never ceased to defy logic. It annoyed him, but it was the only point of leverage he had left since his sucker punch landed so damn hard.
This whole thing required a series of perfect little things to fall in line.
Pushing Halstead through the CT line and clearing the path to surgery was one thing -- but it certainly wasn’t the only thing. No, Archer had reserved the most difficult task for himself.
Quite simply, he didn’t trust anyone else to pull it off.
Halstead’s survival was his survival at this point, so Archer wasn’t taking any chances.
And he wasn’t scared of anyone or anything, Archer wanted to make that very clear. All the same, the impending confrontation wasn’t one he relished. He’d wanted to take on Sam Abrams for awhile, that much was true. But he would have preferred to play on a level playing field. Archer was the one asking for a favor now, and it was going to be tough to spin that into a position of power.
Still, Archer wasn’t a quitter.
He was going to try.
In the surgical ward, he quickly noted the room assignments and skipped the desk. Instead, he went straight to the room, entering into the gallery without invitation. From a quick glance, it was easy to see that the operation was well underway. In fact, Archer knew just enough about brain surgery to see that Abrams was almost done.
Wishful thinking, maybe, but there had to be a few lucky breaks today. Deep in concentration, there was no way the surgical team was going to see him. The circulating nurse, however, met his eye and ducked out of the room and making her way into the gallery.
“Can I help you?” she asked, and she almost sounded helpful.
They would see just how helpful she was.
“I need Dr. Abrams,” he said, inclining his head to the operating room visible through the window. He smiled as he added all due inflection. “Now.”
She looked competent, but the nurse didn’t seem to catch the full meaning of what he was saying. Instead, she deferred to the party line. “As you can see, Dr. Abrams is in surgery right now. This isn’t a good time for a consult.”
“This isn’t a consult, and I know for a fact that Dr. Abrams is not in the middle of a surgery, but the end of one,” Archer said. “So, I really don’t want to hear your excuses, but I do want to see you going to get him.”
To be fair, she didn’t waffle like he might have hoped -- or expected. There was something to that -- Dr. Abrams was an insufferable asshole, but he was one of the few people here that knew how to run his staff -- and Archer might be impressed were he not so damn annoyed at the tedium while Halstead continued to bleed into his skull.
“Closing is not the same thing as done,” she said, and her smile took on a saccharine quality now. “I’m sure you can understand just how delicate and important the closing process is, and Dr. Abrams is very particular.”
“Yeah, that’s all well and good,” Archer said. “But the case I have is one he will want -- trust me.”
She was looking increasingly unimpressed -- her smile had faded completely by now. “If you just wait thirty minutes -- maybe an hour--”
The utter lack of respect was almost funny, but this day was getting too long, too annoying, too everything. Archer couldn’t find his smile now, not even for the most sarcastic reasons. “No, now way,” he said. He stared her down as hard as he could. “Get him now.”
She squared her shoulders, ready to stand her ground. “Dr. Abrams--”
The party line wasn’t going to save her now -- and it wasn’t going to save Halstead either. Archer stepped forward, eyes like ice, as he told her in no uncertain terms what he expected right now. “Tell Dr. Abrams to get his ass out here -- now,” he said. “And if he still objects after the consults, I’ll pay his fees for this surgery myself.”
Her lips drew into a line, marred with disgust and disdain. However, she at least knew her place. She was a nurse. He was an attending. No, he was the head of the damn ED. Of course she knew her place.
“Okay,” she said, regarding him coolly now. “But he’s not going to be very happy.”
“Well, I’m not very happy either,” he snarked at her. “So he may as well join the club today.”
-o-
All his bravado aside, Archer was aware of just how precarious the situation was -- for him and for Halstead. He could talk big and make stark demands, but this wasn’t something he could accomplish on his own. He needed Abrams on board -- and he needed him on board fast.
Archer paced back and forth, trying not to think of the weight of each second. He had tried to remain in control during this whole ordeal, but he could still feel his fingers tingling. This was his fault, was the thing. This was his fault.
He had to fix it.
He was trying to fix it.
He closed his eyes, breathing through the spike in anxiety.
He was going to fix it.
The tendrils of panic threatened to take hold in the pit of his gut, and he could feel the anxiety as it coiled in his lungs. His breathing quickened; his heart rate increased. Sweaty forehead, clammy palms -- Archer wasn’t going to lose control.
He just wasn’t.
The would-be panic attack was subverted, though, when he felt his iPad buzz. He glanced at it, eager for the fresh notification.
Especially this particular notification.
Halstead’s scan was up.
April and Doris had come through on at least that much, then. Clicking through the approval, Archer let it load in the file, rotating the device to get a closer and better look.
It didn’t really matter. Nuance and detail were not required to understand the scans.
Massive hemorrhage. Not from the punch, but from the impact with the counter and floor. Located in the back of the head, in the cerebellum. The diffuse matter had spread, though, involving nearly the entire brain. They needed to evacuate the blood quickly. They were up against the clock -- even more so than Archer had realized.
The chart updated again.
Halstead had been moved to pre-op with surgery scheduled with Dr. Abrams right now.
That was good.
Now, Archer just had to get Dr. Abrams to agree.
As if nearly on cue, Abrams came storming out of the OR. The door banged into the hallway, and the neurosurgeon rounded on him with spite and vengeance. “Who the hell do you think you are?” he asked without pretense. “I almost ignored you as I would be well within my rights.”
This was something of a power play. Archer would have resisted it on principle alone, but this time, he had good reason to dig in his heels. “Hold your horses and listen. This is important.”
Face pinched so hard that it looked literally painful, Abrams glared at him. “I will give you one chance here, or I will file a complaint against your unprofessional and, frankly, annoying behavior.”
If Abrams wanted to go personal, then Archer had the luxury of the high road for the moment. How he got there was not important. “It’s not for me. It’s a patient.”
Abrams did not look impressed. “It’s always a patient,” he snapped. “And I just left mine, so you better have something good for this utter lack of respect and the complete disregard for protocol. Don’t even get me started on your smug stupidity.”
“Look, I don’t care about your bitching and moaning,” Archer said. “They said you were closing, and I know that Evans is just a resident, but she’ll handle it just fine.”
Abrams looked nearly apoplectic. Their working relationship had been tense, to say the least, and Archer knew that while he could boss anyone around the ED, he would have to hold his own against a guy like Abrams. “You think you can order me around?” the neurosurgeon asked, fully indignant. “You manage the ED -- not neurology.”
Archer held out the iPad, undeterred. “Exactly,” he said. “And right now I need the best neurosurgeon in Chicago or this patient is never waking up again.”
With a moment of reluctance, Abrams eyed him. It wasn’t mere vanity that gave a man like Abrams pause, Archer knew it wasn’t that simple. No, it was curiosity. If Archer posed it as a challenge to him, then the other man would inevitably want to know more. He took the iPad and gave it a cursory look. Dispassionate though he was, it wasn’t hard to see him make the quick conclusion about the severity of the injury he was looking at. Halstead’s CT had revealed exactly what Archer expected: a massive brain bleed, hemorrhaging into his skull, putting pressure on his brain, increasing his odds of impairment or death with every passing second.
Archer had made the diagnosis without even seeing the scan.
Abrams took approximately five seconds to come to the exact same conclusion.
When he looked up, the anger was gone. Abrams regarded him with the cold diagnostics of a clinician. “Whose scans are these?” Abrams asked.
Archer stood his ground, because he’d staked out this position before Abrams had even known what was what. “Will Halstead.”
“No, the patient,” Abrams said tersely. “Who’s the patient?”
Archer had already girded himself to this truth. “Will Halstead,” he repeated, more staid this time. “Will Halstead is the patient.”
Sam Abrams was a conceited son of a bitch, but he at least had the decency to not mince words with protocol and smalltalk. His face registered a moment of surprise, but he quickly recovered to speak. “I’d ask what happened, but the more relevant question is when were these scans taken?”
Archer didn’t flinch. He couldn’t flinch. When you were that far in, you just had to keep going. “Five minutes ago.”
Abram’s expression pinched off even more, making it look like he’d sucked on a lemon. “He needs to be in surgery now.”
“He’s already being prepped,” Archer explained. “Just waiting for you.”
Abrams looked at scans again. His expression was grim, but he still nodded. “This could work.”
Archer didn’t do much with hope, but he knew Abrams well enough to know what he was capable of. Ethan could still walk because of this jackass, and he had to hope that Will Halstead wouldn’t be a damn turnip when this was done. And maybe, just maybe, Archer would still have a job. “You think we’re in time?”
Abrams looked at him coldly. “I think he has ten minutes -- tops -- before this bleed is catastrophic.”
Archer felt his stomach tighten, and the tendrils of panic threatened his collected demeanor. Friendly fire was just as deadly as an enemy combatant, but there were times when Archer couldn’t remember what the hell side he was even on anymore.
All he knew was that he couldn’t let Halstead die.
There were enough skeletons in his closet.
This was one he did not want.
“Then, you better get moving,” he said. “You need help?”
Abrams was already moving, lip curled as he glanced back. “Not from you.”
That one smarted more than Archer wanted to admit, but if this wasn’t about Abrams’ pride, then it couldn’t be about his own, either. It was his punch that started this, even if Halstead did have it coming. If Halstead died--
Well, that was a postulation Archer didn’t want to consider.
He was too old to start over.
He was too old for another stain on his conscience.
Hell, he just plain felt too old -- period.
“Fine,” he said. “Then you better get moving.”
Disclaimer: I own nothing here.
A/N: Set post S6, but written before ever seeing anything in S7. Therefore, I guess this is technically AU at this point. Don’t mind the supreme overuse of medical nonsense. If you’re someone who craves accuracy in all things, don’t keep reading. I am fast and loose with the medical side of things, and I make no apologies. Fill unconsciousness square for
hc_bingo. Very, very unbeta’ed.Summary: He lost control, for a second, just for a second, and it wasn’t supposed to happen. One punch -- the most unlucky damn punch in the entire world.
PART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
The truth be told, Archer hadn’t come to Chicago Med looking to take over. No, Archer was at his core a very pragmatic individual. When his old position had been eliminated, he’d realized very quickly just how limited his options were. He was a damn good surgeon, but the country was full of good surgeons. At his age, and with his limited background at a smaller hospital and army postings, he just wasn’t going to be a big-draw hire.
His options consisted mostly of other small-time hospitals or, worse, clinics, where he’d be lucky to get a comparable attending position. At his age, this would feel like a setback, but he’d resigned himself to that inevitability because the only other option was early retirement.
Early retirement would be a death sentence, and he knew it. He had enough trouble being alone inside his own head, and to face that without a job? Without purpose?
That wasn’t going to end well.
He’d been preparing to send out his resumes when he got the call about the Med job, and he probably would have taken it no matter what, but then he’d found out that the position was with Ethan and he’d thought, slam dunk, no brainer, he’d hit the jackpot.
Of course, when he got here, he realized it wasn’t with Ethan, but for Ethan, and that for all that Chicago Med was touted as the best in the state, it was still staffed with half-assed dimwits who were more distracted by their personal drama than patient care. The pithy nurses who made all sorts of assumptions. The brazen charge nurse who thought she was all that but spent more time fussing about her family.
And the doctors.
The damn doctors in that place. Difficult and whiny. They were busy hooking up or running inane drugs trials. Even Ethan, who he himself had trained, had fallen victim to him. It was disheartening that he was just as bad as the rest of them.
Considering this, getting named head of the ED was a stroke of absolute luck.
His luck, of course, given that Ethan had been trying to fire him.
And theirs. This ED had no idea how much they needed someone like him to get things whipped into shape. It was a coincidence he wasn’t going to take lightly, especially since he knew that his window of opportunity was scant. Ethan’s recovery timeline was long, but not that long. If Archer was going to clean house, he had to get to work and stay focused.
Ethan would thank him for it.
Goodwin might just promote him for real.
He had already managed a few nurses, getting a few less savory figures transferred, and he got one to up and quit. April had put in her notice, so he didn’t have to worry about her for much longer, but the doctors were a harder sell. He had scared a few of the residents into playing to his own strengths, and it was fairly easy to take control of the med students to set the tone to his liking. The attending were more annoying, however. They were just too set in their ways, and they thought they knew what they were doing.
They didn’t.
Sure, they manage to save some lives, but they could be so much better. Archer was just going to have to get a few of them to realize their fortunes were better elsewhere. Firing them would be hard, it seemed, but getting them to quit?
Well, Archer might be able to do that.
All he had to do was set standards.
And watch them fail,
Starting, naturally, with the weakest link of all, Dr. Will Halstead.
Halstead was inexplicably popular in the ED. Despite the fact that Archer was in charge, people seemed to go to Halstead first for his opinion and support. The guy had literally no standing, but people always wanted to know what he thought.
The stupidest part was that Halstead’s judgment was 100 percent suspect. The guy had openly botched his own clinical trial. For his ex girlfriend, no less. He nearly killed her mother, blew up the career of his current love interest, who was way out his league, by the way, and still lost the girl anyway.
Oh, and the asshole had been fired.
Kicked out on his ass.
Archer wished he could have seen it, and he couldn’t conceive why Goodwin had hired him back. The fact that Halstead hadn’t stolen the drugs in first place seemed like splitting hairs. The guy was clearly a disaster who had no place in a well functioning ED. Goodwin must have been feeling sentimental that day, and now Archer had to live with the aftermath.
Because they did love Halstead. Maggie gave him the best cases. Crockett preferred his second opinion. The nurses wanted to be assigned to his patients. The residents went to him for help. Attendings sought him out to commiserate.
It was ridiculous. It was stupid. It was annoying.
It was flat out untenable.
This was Archer’s ED for now. He needed to take charge of it now -- before he was out of time to make his mark indelible.
He had a whole list of possible changes to make, some of which he’d already begun implementing on a micro level. But he was running into resistance from the staff, and he just needed one domino to fall to get them in line. As best he could tell, Halstead was the ideal domino. Influential with the staff but precarious with the administration, Halstead had the connections to make him a prime candidate.
Plus, Archer just didn’t like the guy.
He was inconsistent -- brilliant one minute and an idiot the next -- and it was all about emotions. He was swayed by all the wrong things, and he just wasn’t that interesting as he slept around the ED and made obvious bad choices for sentimental reasons. They were all there to save people, but Archer had the common sense not to walk around like a self righteous, red headed moron.
On top of all that, Halstead had made himself an easy target. After getting fired, Goodwin had been convinced to offer him back his job -- but it was clearly a pity play. Ethan was out for awhile, and with Manning gone, she probably felt emotionally strained at the idea of losing another long-serving member of the staff. She was a smart woman, but even she was prone to sentimental failings from time to time.
That said, Halstead was obviously on the thinnest ice available. He had a job, but he was strictly on probation. One wrong move, and Goodwin wouldn’t even need to think about it.
All Archer had to do was amplify that move -- make sure it happened.
In short, if he pushed the right buttons, Halstead would all but fire himself, the predictable, self righteous asshole that he was.
Archer had been looking for his opening for a few days now.
And today, Halstead handing him the opening he wanted on a silver platter.
It was his patient.
A woman with terminal cancer -- check.
A patient with an ironclad DNR -- check.
Halstead in charge -- check.
DNR magically averted and extraordinary measures applied -- check.
The final checklist that Archer needed to seal Halstead’s fate.
Sure, there were copious notes in the file explaining the extenuating circumstances, but still. Still. Halstead had a history of going off-book and disregarding medical ethics. His judgment here was inevitably and intracvertibly suspect. Everyone knew it. Hell, Archer hadn’t even been here for most of the indiscretions, but they still lived on in ED infamy.
Now, all Archer had to do was get Halstead to own to it.
Technically, that wasn’t necessary -- Archer would raise the concern with Goodwin either way -- but it sure was fun to needle Halstead. Something about his smug face just invited it, as far as Archer was concerned.
With this in mind, Archer cornered Halstead in the doctor’s lounge. The guy was getting a cup of coffee, and no one else was around. Archer went inside, pretended to wait his turn at the pot, and started up the talk.
“Long day?” Archer asked, making a slim attempt to be coy.
Halstead nodded with a slight hum.
“I mean, filling up on coffee at, what? 2 PM?” Archer pressed.
Halstead had his cup and was stepping out of the way for Archer to get his. It was a gesture that Archer ignored, even while Halstead stirred creamer into his cup.
“All the days are long,” Halstead said. “I worked an extra shift last night.”
“Right,” Archer said. “Still trying to prove yourself, right? Get in good with the boss?”
Halstead gave him a bland, uncommitted smile. “Just trying to pitch in.”
Archer still didn’t bother with coffee, watching as Halstead went over to the table and sat down. He took a sip while getting out his phone, and Archer narrowed his eyes at him willfully. “I figured it was probably about the case you pulled this morning,” he said.
Halstead looked at him, face not registering much surprise.
“The DNR case,” Archer said, leaned back on the counter as though this were benign small talk. “A mother with small kids. Cancer.”
Halstead stiffened a little, as if he noticed for the first time that this line of querying wasn’t innocent. “It was all pretty by the book,” he said. “I made sure to put it in my notes.”
Archer nodded but made a face. “But you do have a history of these cases--”
Will put his coffee down and drew a breath that seemed to be an effort of self control. “Cases I learned from,” he said. “There were no mistakes in this one.”
“No mistakes,” he repeated, nose wrinkled a little more now. “You just magically convinced your terminal cancer patient to reverse her DNR within one hour of knowing her?”
Will nearly abandoned his coffee now, getting up instead. “The circumstances were extenuating,” he said. “She was in for a car crash; her cancer treatments are working well to give her a sustainable quality of life. The DNR was for her end stage cancer treatment, not accidents. Her family agreed. She signed off on it. Dr. Charles consulted. Two nurses witnessed everything. There’s nothing magical about it.”
It was a lengthy defense.
The truth was often a lot simpler.
Archer pursed his lips. “Um, great. So all I’m hearing is that you changed a patient’s DNR status but were smart enough to cover your tracks this time,”
Will scowled, picking up the coffee cup and dumping the remains in the sink before leaving the cup to be washed. “You have the chart right in front of you, so you know that’s not what happened,” he said, moving around Archer to throw his napkin in the trash. “And you can talk to the patient’s family -- there are no objections, no accusations of anything. Also, for what it’s worth, the patient is expected to fully recover.”
“All the same, given your, uh, history, we should get this case reviewed by Goodwin,” Archer said with an innocent shrug.
Halstead just shook his head, making no attempt to rise to the bait. “You know what?,” he said, brushing by Archer to the door now. “Be my guest.”
Archer had his opening. There was no way in hell he was letting it slip by. He squared his shoulders, planted his feet and shoved his hands in the pockets of his coat. “Do you have a problem with me, Dr. Halstead?”
Will turned. His expression was somehow incredulous. “Do you have a problem with me, Dr. Archer? Because you seem set on second guessing everything I do.”
Archer at least had cause to be incredulous. “Of course I am. As you were fired for major indiscretions, I think some extra scrutiny is absolutely valid,” he said, his tone cutting. “In fact, I think I would be remiss as the head of this ED if I didn’t watch everything you do.”
It wasn’t meant to be a low blow as much as a direct hit. Archer wasn’t one for nuance. He preferred to go after things with the finesse of a tank, and playing nice wasn’t his style. He wasn’t sure where Ethan learned diplomacy. But it clearly was not from him.
To Halstead’s credit, the blow didn’t make him fold. He turned, squaring up his stance as well, ready to fight, just like Archer had intended.
“I was fired, but then I was reinstated -- and cleared for duty by Ms. Goodwin herself,” he returned, yielding nothing. He lifted his chin in a telltale sign of defiance. “If you don’t trust my professional opinion, then I’m not sure how this works, because she does.”
“Oh, your professional opinion?” Archer said with a caustic laugh. “Is that the professional opinion that tanked an entire trial for a woman who didn’t even love you anymore or the one that nearly left Dr. Choi an invalid?”
Now, that one was a bit of a low blow. If he wanted Halstead to take the bait, he had to make it enticing. The look on his face bordered on contempt now, so Archer felt like he was probably on a viable track.
“You have no idea what you’re talking about with Dr. Manning, and you got lucky with Ethan and everyone in the ED knows it,” he said, and his voice was hard now.
But if Halstead thought he was winning this fight, then he was truly as dumb as he looked. He stepped forward, and he didn’t have to sneer. Condescension would work just fine on Halstead’s already damaged ego. “It’s called intuition,” he said. “I have it, and let’s face it. You don’t.”
It was a good shot, but somehow, this time it missed. Halstead let the tension drain from his shoulders, and he eased back in his posture. “The good news is that none of this matters. Ethan will be back soon,” he said,and his lips almost returned up into a smile. “Then you will just go back to being that annoying, bitter colleague that everyone hates but is just too nice to tell that to.”
Condescension was effective, you had to give the asshole that. Halstead hadn’t taken the bait, and Archer felt his own ire rise.
Who was this guy?
What kind of right did he have here, to talk to Archer like that?
How the hell did someone like Halstead still have a job?
Why had no one wiped that dumb look off his dumb red head?
Halstead looked pleased with his comeback, and the little prick turned to leave, as if that were that.
That wasn’t that.
There was no way.
Archer was older, wiser, smarter, better. Someone needed to teach Halstead a lesson, and if Archer accomplished nothing else, then this would be his legacy, so help him God.
Fingers curled, breath baited, Archer wasn’t conscious of his next choice even as he was already making it. Patience, impulse control, whatever.
“Halstead,” he said, drawing the other man back around.
And before he knew it, before Archer knew it, his fist was flying through the air, aimed directly at the stupid, smug look on Halstead’s face.
The punch caught Halstead on the temple, and it was harder than Archer had intended to throw. He lost track of stuff like that, sometimes. He couldn’t always tell the difference between a little and a lot. Nuance was not particularly his strong suit. It was right up there with patience and self control as things.
That said, there was no denying it was a lucky punch. Halstead went down immediately, spun by the force of the blow he hadn’t seen coming. The suckerpuch had blindsided him completely; it was likely that he didn’t even have a clue what had hit him.
His backward trajectory was unstilted, and as he fell, he hit hard against the counter. The thwack was sickening, and Halstead’s descent to the floor was harder still. He landed without protecting himself from the fall, and his head rebounded once before he settled, sprawled and still, on the lounge floor.
It happened fast. Within a second, Halstead was up and smirking and then down and out. Archer’s fist ached, and he felt a momentary flicker of satisfaction. He’d been wanting to lay Halstead out for three weeks now.
The satisfaction was short-lived.
Because he hadn’t just laid Halstead out.
He’d knocked him out entirely. As a doctor, Archer had seen a range of unconsciousness. As a man with a temper, he’d been in his share of fights. A simple punch to the head could make you black out and wake up with a headache and some shame. A punch like that? With two secondary hits?
Well, people got concussions from things like that.
And Halstead wasn’t moving. Not as much as a twitch.
As an army surgeon, he was trained to make split-second assessments. Those quick-thinking diagnoses had saved countless lives in the field. It was one of the things he was well and truly good at. His first instinct was usually the right one.
Halstead had more than a concussion.
No, Archer had knocked him senseless.
Punches like that, hits like that, falls like that -- people turned into vegetables from injuries of that caliber. Sometimes, they died. Sometimes, you just wish they had.
Archer had wanted to punch the smug look off Halstead’s face, but kill him? Archer hadn’t been thinking when he threw the punch, but he was thinking now. He was thinking about the fact that he’d just lost his self control -- again -- and put the life of one of his colleagues at risk -- again. Ethan had survived. Halstead--
All his character flaws aside, Archer was still a doctor. Springing back into action, his adrenaline kicked in. Crossing quickly, Archer dropped to his knees, quickly pressing two fingers to Halstead’s neck. He had a pulse.
He bent down, close enough to hear Halstead’s heart. Fast and thready. Breath sounds were barely discernible. He wasn’t moving enough air.
Sitting back up, he quickly took his penlight out of his pocket. Swiftly, he opened Halstead’s eyelids one at a time, but there was no pupillary reflex. With a field neuro exam, Halstead failed on every count. He had a GCS of 3.
There were half a dozen things that could account for this, some of them relatively benign. But Archer knew. One lucky punch, and now Halstead was hemorrhaging. Half of patients with a brain bleed didn’t even make it to the hospital. Halstead had the odds skewed in his favor since he was already here, but only marginally so. Even with prompt treatment, another 30 percent of patients died. Of those who survive, up to 40 percent could be left with permanent deficits ranging from mild to severe.
That wasn’t a lucky punch.
That was the most unlucky punch in the world.
Which meant Archer needed to act.
Now.
All of Archer’s weaknesses, you couldn’t say he was bad in a trauma. Moving quickly, he got to his feet, getting to the door in a few wide steps. He opened it without hesitating, calling out to whoever happened to be closest. “Quick, I need a backboard -- now,” he said.
Naturally, yelling for a backboard in an ED wasn’t exactly unheard of, but there was a process for these things. Most of the time, acute injury happened outside the hospital. People got lazy with the paramedics doing the triage for them. It deadened their response times during actual conflict. Most of these ED employees would fall to pieces in an actual warzone.
It was still a point that drove Archer crazy.
It was also a point that might cost Halstead precious minutes.
“A backboard!” he yelled again. “Now!
Most people just looked dumbfounded. Maggie, who was the one person he might expect to be on top of things, was the only one with the wherewithal to approach.
Just approach, mind you. She looked confused at his request, holding that damn phone of hers like some idiotic lifeline.
She acted like the whole world could be controlled there. She had gotten softer than any of the rest of them. Honestly, Archer wasn’t sure she was fit for these trenches anymore. “What?”
He didn’t have time to baby her. More to the point, Halstead didn’t have time. His brain cells were probably dying as she gawked, and Halstead couldn’t afford to lose many. “It’s Halstead,” he said flatly. “He's hurt.”
Simple English, straightforward language, and she looked more confused. “He’s what?”
Halstead wouldn’t stand a chance with her. Maybe he should have tried to get a new charge nurse instead of fixating on Halstead. Rolling his eyes, he crossed in front of her to one of the supply stations to retrieve it himself.
By the time he made it back to the lounge, Maggie had already entered ahead of him. She stopped short and made a strangled sort of noise in her throat. Archer pushed by her brusquely, and Maggie fell into step before going to her knees next to Halstead’s prone figure, still and spread-eagle on the floor. “What happened?”
The lack of professionalism from her was appalling. Everyone loved Maggie, but Archer didn’t see it. A new charge nurse was definitely in order. She had been given too much latitude for far too long.
“He hit his head,” Archer explained in the simplest terms possible so she could keep up. He positioned the board himself, bringing it alongside Halstead, when she seemed too shell shocked to participate. “Hard.”
Gently, with years of practice honed on the battlefield, Archer reached down and supported Halstead’s neck while rolling him to the side with his other hand. There was a smear of blood on the floor, and more of it was matting Halstead’s hair on the back of his head. Finally, Maggie remembered that she was a trained nurse and had the wherewithal to help. She grabbed the board, sliding it into place while Archer eased Halstead down. He continued supporting his c-spine, and Maggie started strapping him down.
When he was secure, Archer moved to the head to lift him, thankful that Maggie at least had the presence of mind to pick up the backboard at Halstead’s feet. He was heavier than he looked -- the bastard was a tall son of a bitch -- and Archer hoisted him between the two of them, hoping that Maggie wouldn’t be stupid enough to drop him.
That would be the last thing Halstead needed -- another head injury. Archer intended to make sure the guy still had a few of his scant brain cells left after this debacle.
It wasn’t easy opening the door and navigating the backboard out into the hallway, but Maggie was actually ahead of him on this. With the door open, she called out quickly. “April, Doris! We need a hand here!”
The two nurses came rushing over -- along with the rest of the ED. For some reason, Halstead remained impossibly popular with the staff, and the ED had the trappings of a high school with its penchant for gossip and hookups. Archer knew this rubbernecking, therefore, was inevitable, but it made the situation a touch more uncomfortable. He had wanted this altercation to be more of a private matter. This publicity wasn’t part of the plan.
And okay, the head injury wasn’t part of the plan, either.
Things were going a little off course for Archer today -- and all the other days. Life after the military had not been particularly easy for him, and this kind of crap, right here, was why.
“What’s open?” he asked, face set taut as he dared the rest of the ED to come any closer. “Maggie?”
“Uh--” she said, faltering.
“Baghdad,” April blurted. “They just finished prepping Baghdad.”
Normally, Archer might consider that overkill, but he was dealing with a suspected brain hemorrhage, and time was short, so he wasn’t going to dicker about the details.
“Okay,” he said, shifting his direction to move to the main trauma bay. “Get in there -- I want him on an IV and monitors.”
April and Doris scurried ahead of them, and Archer barked to the rest of the ED with a glare.
“Back to work!” he said. “This isn’t a sideshow! We still have work to do!”
It was an unsympathetic tact, but it was the only reasonable option. They did have an ED to operate, and sentimental pandering wasn’t going to help. Halstead needed a normal trauma team, not half the ED sobbing over him. He doubted Halstead would want it anyway.
And if it happened to buy Archer a little time to figure out how to explain this situation?
All the better.
The trip to Baghdad wasn’t terribly long, but Halstead’s dead weight felt more pronounced than necessary. He banged through the doors with all due haste, directing the backboard to the gurney. Maggie helped him steady it, and soon they had it deposited on the gurney, Halstead still unconscious and strapped down.
Despite invoking Doris and April to help out, Archer was still the only one doing anything. He turned the trauma lights on, pulling the trays nearby and ripping the protective packaging clear. Under the harsh lights, the bruise on Halstead’s temple was starting to blossom, and the milky color of his skin took on a nearly translucent hue.
“Come on, people,” Archer chided. “We need to get him set up on the monitors -- I want vitals!”
April had come up on the other side of Halstead’s gurney, and Doris seemed to be at one of the carts. He wasn’t sure what the hell Maggie was doing at this point, and he was well aware that his earlier order to get back to work was being ignored by mostly everybody. The room had already collected a small gallery, and Archer caught a glimpse of more people just outside.
Which was perfect.
Archer totally needed an audience for this.
He glared at Halstead. The guy couldn’t even take a punch without being difficult.
This was really turning out to be a long, miserable sort of day -- and Archer wasn’t even the one with a head injury. His head pounded like he might have one, but no. That was just the incessant stress of being alive and living among idiots.
Somehow, April had only managed to get the pulse ox monitor on. He wasn’t sure what the hell Doris was doing, and Maggie looked like she was crying. Halstead, looking worse by the minute, was clearly tanking -- and in a fit of frustration to get this trauma moving, Archer cut Halstead’s scrubs clear and grabbed the IV kit himself. He half pushed Doris out of the way, unfolding one of Halstead’s arm to get better access to the veins.
“Can I get a tourniquet?” he asked, but no one was listening. April had managed to hook up a few of the leads on the chest, and Archer rolled his eyes, sloppily tying off Halstead’s bicep in an attempt to speed up the process of starting the IV.
Starting an IV was an annoying process, and admittedly, Archer hadn’t had to do one on his own in years. He could feel himself start to sweat. He stole another glare at Halstead, still out cold on the gurney. How did this asshole get the easy job here?
He missed the vein the first time, and his jaw locked. Self conscious, he cast a glare in the direction of the crowd.
“Didn’t I tell everyone to get back to work?” he said, voice cutting and caustic. “There is still such a thing as patient privacy, and Halstead’s rights don’t go out the window just because he happens to be on staff.”
He got the vein with this second attempt, and he pulled the needle back, testing the flow. April seemed to have the leads running, and Doris had come to her senses enough to start turning the monitors live.
“If you won’t do it for Halstead, do it for yourself,” Archer snapped, his patient thoroughly spent now. “Anyone still in here in the next five seconds will be fired. Now go.”
He must have sounded pissed -- and he was -- because the crowd slowly disperse with a few stragglers leaning back. Archer glanced up at them, eyes locking on Maggie, who hadn’t moved from her spot at the end of Halstead’s gurney.
She had proven herself utterly useless. “You, too,” he ordered her with a terse nod. “I only need April and Doris. More people than that, and it’s just going to be a distraction -- and Halstead can’t afford any of those, so I suggest you get the hell out unless you would like to compromise his critical care.”
Maggie’s breathing clearly caught, her chest hitching as she showed extreme reluctance to comply. Archer didn’t yield, though, and playing the critical care card was a convenient guilt trip.
And a real one.
Halstead really did look bad.
Archer figured Halstead was selling the urgency here as much as he was, because with one last look, Maggie turned and left, taking the last of the gallery with her.
With them gone, Archer hung the IV, attaching a liter of saline and starting the drip wide open. On the other side of the gurney, April had finally finished getting the leads set up, and Doris had the monitors fully operational as the first round of vitals came rolling in.
“BP is low -- and dropping,” April said with a tight inhale. “His heart rate is inconsistent and thready.”
April was keeping it together, if only just. Doris wasn’t doing quite as well.
“O2 levels are at 75,” she said. A muscle tightened in her jaw. “And also dropping. Fast.”
“He’s barely moving air,” Archer said, noting to himself that this was consistent with his working diagnosis. No doubt, Halstead had diminished brain function with the building pressure in his skull. Their window to address it before the damage was permanent was closing fast. “We need to intubate now. Someone get me prepped. A milligram of ectomodine and another of sux.”
He watched as Doris grappled for the drugs, her fingers trembling as she reached for the line.
Archer busied himself back with Halstead. For good measure, he checked his reflexes once more, but he didn’t respond. Even with knuckles to the sternum, Halstead remained utterly limp.
Doris, finishing with the second injection into the IV, was beside herself. “He’s got a GCS of three, doesn’t he?”
Because panic was exactly what Archer needed right now. It defied all common sense how Ethan had operated this ED; at this point, Archer wasn’t even sure it was salvageable. He just wanted to fire them all and start over -- for all their sakes. “We have to keep focused, please,” he said, grinding out the words in an attempt to make his point and not ball his fist once more.
He usually liked Doris, who knew how to ruffle feathers, but this trauma was showing her limitations. “But what happened?” she asked.
Everyone had a thousand questions, but Archer had a singular focus. If he was right -- and he had no doubt that he was right -- Halstead was currently bleeding in his skull. There was no time to waste on questions or explanations.
“Look, we were fighting, okay?” he snapped. “Words were spoken, punches were thrown. Now where is the damn ET tube so I can get some oxygen in him?”
April produced one, but she still looked shellshocked as she handed it over. “Words? Punches?” she said. “I don’t understand. Will was totally fine today.”
“Well, he’s not fine now,” Archer muttered, tipping Halstead’s head back and looking for his angle in order to visualize the vocal cords. “Did someone push the etomidate and sux?”
“Already on board,” Doris reported, adjusting the IV that had been hung hastily.
Archer shook his head, because there was no change in Halstead. “He wasn’t protecting his airway at all anyway,” he said, starting to slide the tube in. There was no resistance, and he felt it all the way down, until the end was properly situated in the airway. “Okay, someone start bagging him.”
April at least had that down. She hooked up the bag quickly and started ventilating with efficient, clean motions. While his chest inflated dramatically, Archer took a stethoscope and placed it over the lungs, waiting to hear the telltale signs of proper function.
“Placement’s good,” he reported, checking both sides of the chest. “Breath sounds are equal.”
April turned a keen eye to the monitor. “O2 levels are rising. Back to 88 and climbing fast.”
“Good,” Archer said. He eyed the monitors again. “BP has risen slightly with the fluids, but it’s not as stable as I’d like.”
“It still doesn’t make sense,” April said, keeping the bag steady over Will’s lax features. “What were you even fighting about?”
The question grated against Archer’s very last nerves; he did his absolute best to ignore it. “Can one of you do a blood draw?” he asked. “I need to run a full metabolic panel, and let’s type and cross, just to be safe.”
“It’s really not like him, is it?” Doris said, the question directed more at April than Archer as she reached for a blood kit. “I know he’s impulsive, but I’ve never seen him throw a punch -- not one -- even when someone deserved it. This whole thing -- it’s not like him.”
“Apparently it is,” he muttered, but the condescension was cut short as he looked at the monitors again. Halstead had stabilized his oxygen levels, but the rest of his vitals suggested that the complications were just starting. The BP was starting to tank again; the fluids weren’t going to be enough. “And we don’t have time for this--“
As if to prove his point, Halstead went rigid a split second before his legs started trembling. Within seconds, his entire body was jerking. Normally, Archer would welcome the unexpected backup from Halstead, but the asshole really knew how to pick his moments.
“Damn it,” he hissed, already going through his revised diagnostic protocol. The seizure didn’t change his working theory. Instead, it solidified it. Halstead’s condition was getting worse.
Everyone else in the room was two steps behind him.
“Head injury?” April asked. She sounded concerned. “They happen with concussions.”
“Yeah, and with brain bleeds,” he added tersely.
April’s concern ramped up instantly. She spoke in alarm because for some reason, she hadn’t posited the most likely conclusion here. “You think--“
His patience thin and Halstead still trembling unabated, Archer reached for the drugs himself, pushing aside vials that clanked noisily on the cart until his fingers locked on the right one. “I don’t think, I know,” he corrected her. He handed the vial to Doris, who was closest to the IV. “Give me 5 milligrams, and let’s hope it makes a dent.”
Still wide eyed, Doris was just bright enough to know what to do without being too bright to question him. It was how Archer liked his nurses: competent but without much independence.
April, on the other hand, was beginning to piss him off as much as Halstead. It was a good thing she was leaving, or Archer would have to reckon with that sooner or later.
April persisted, bless her heart. Loyalty to an undeserving recipient in Halstead, an overly inflated sense of ego, whatever the case may be. “But it could be a concussion, skull fracture--“
He watched Doris administer the drugs, keeping Halstead on the edge of his vision. He counted the seconds in his head, calculating the odds of brain damage based on the length and severity of the seizure.
“Or a hemorrhage, just like I said,” Archer said. At that moment, the tremors started abating. Within another few seconds, Halstead went limp again with his limbs lax and his head tilted just to the side. The only sign of life was coming from the manual ventilations through the tube in his throat. The seizure was over at least, but the fight for the asshole’s life was far from over. “Doris was right. His GCS is three. He is completely unresponsive, and we’re having trouble keeping his vitals up. We could play the odds, see if it’s just a concussion, all while we let his brain die and he ends up in a vegetative state or worse.”
Archer didn’t need to raise his voice or get in their faces to make his point dominant.
No, he just needed the facts.
And the guts to make the perspective clear when everyone else was busy playing Little Miss Sunshine.
“Or,” Archer posited now that he had their attention. “We could treat him aggressively and save whatever may be left of his brain. So, I want to get him up to CT--”
He had thought he’d made his point, but April was like a bad song stuck on repeat. “It’s backed up--” she started, still pressing air into Halstead’s lungs.
Exasperation didn’t describe his emotions any longer. They had long since past that, and Halstead’s vitals were only going to continue to decline. The fluids and meds bought them some time, but not much.
Probably not enough.
“Then unback it up, cut it line, I don’t care,” he said, marking off the critical to do lis5 in his head. “Get his blood drawn and off to the lab, and make sure they know it’s a rush job. I want results in 15 minutes. Then, someone go grab Abrams and tell him he’s got a case--”
Doris was drawing the blood from Halstead’s other arm, filling up two vials and capping them. She looked at Archer with concern. “Abrams has been unavailable for hours. He’s in surgery--”
Doris probably thought, in some idiotic misguided way, that she was providing keen insight here, but all Archer heard was excuses that would let Halstead’s limited braincells continue to die in dramatic and unabated fashion. “Yeah, not as pressing as this one.”
Doris was putting stickers on the vials for purposes of identification. “But it’s against protocol,” she said, and no doubt, she only knew this because it was a protocol she’d run up against before. “And he hates it.”
Archer’s frustration was rapidly reaching a breaking point, but a loss of control here would be catastrophic -- for Halstead as much as himself. “I don’t care about Dr. Abrams’ delicate feelings, and protocol will leave Halstead dead,” he said. He tipped his head to the side, gesturing to their patient. “Is that what either of you want right now?”
The pair of nurses -- Chicago Med’s best, God help him -- said nothing, looking at Halstead instead. Archer had a good point, but Halstead made it vividly clear with his pasty skin and the tube down his throat. Since they seemed to like the guy, the fact that he was currently dying was probably going to be enough of a convincing factor.
“But there are protocols in place to call the neuro resident on call,” Doris said, continuing to press on the same stupid tact as before.
And really, it was an inane thing to say. Beyond inane, really. Archer didn’t have the time -- Halstead didn’t have the time. “That’s great, but I’m sure Dr. Halstead here would like not to be brain dead,” he said pointedly. He slowed down his enunciation to mark his point. “Get Abrams.”
“Even if I thought he would do it, we don’t have standing,” April pointed out, with a nod to Doris. “You need to get him out of surgery, do a consult without all the scans--”
Archer sighed, feeling the pressure mount behind his eyes. This day was really getting on his nerves. “Fine, I’ll get Abrams myself,” he said. He pointed to Halstead on the gurney. “You two focus on getting him up to CT -- he’s already prepped, so all you have to do is clear the line, any way you can,” he said, directing his hand to the hallway beyond. “Don’t wait for the results. Transfer Halstead to the OR immediately.”
“But the scans will be needed to confirm the diagnosis,” Doris said.
“And the scans will be loaded within minutes,” Archer said. “I expect to have them in his file by the time I get Abrams out of his OR. Give him a minute to consult, and Halstead’s already prepped in the OR by the time Abrams scrubs in.”
“But what if we can’t clear the line?” April asked, brow furrowed deeply. “What if we can’t secure the OR?”
“Then, say your goodbyes now, because Halstead’s not coming back,” he said, with all the harshness he intended. He gestured to Halstead’s unmoving form once more, letting the tube down his throat and the unnatural stillness of his body prove the point for him.
Doris looked like she was ready to cry again, but April’s face hardened with distaste.
Archer shrugged. They didn’t have to like him. They just had to fall in line. “I’ll leave it to you to decide,” he said. “If you care at all about giving Dr. Halstead a chance, you will do exactly as I say.”
They looked scared, out of their depth, whatever, but he was going to trust them to be professionals for the moment.
It was a tall ask, and given what he knew of this ED, it wasn’t a given. But, Archer had to hope, with their beloved Dr. Halstead at stake, maybe they’d step up their game.
For Halstead’s sake, Archer was reduced to hope.
“Good. Now we can skip the idiocy and start making an actual plan to treat him,” Archer said, making the seamless transition. “Get him up to CT, but stay with him every second. I want him fully oxygenated at all times, and if there is any change in his rhythm, I want to know immediately. Once the scan is run, do not wait for further authorization. Have him set up in any available OR, and prep him yourself if you have to while I get Dr. Abrams on board. In 20 minutes, I want Halstead open on that table, do you understand?”
Doris looked sufficiently cowed, but April drew her lips into a line. Even after everything, she still had to have her say. Ethan must have found that rebellious streak attractive, but Archer no longer fathomed the appeal. “20 minutes is still nearly impossible,” she said, continuing to squeeze the oxygen bag.
“And as far as Halstead is concerned, it’s too much time,” Archer said. “If I’m right -- and I know I am -- the CT will show a massive bleed in his brain. If I had my way, I’d skip the CT and just open him up right here and now. But we have to play by some rules -- even if I fully intend on breaking all the rest. If either of you have a problem with that, the door is right there.”
He pointed to the door, and it wasn’t so much a bluff as an offer he knew they wouldn’t take. They could be dense, they could be stupid, they could be stymied by their own limitations -- but they were still nurses, and they still cared about patients -- and they still cared about Halstead. Neither of them had a plan, and Archer did. That was all that was needed right now.
Too many people thought that leaders had to be better or smarter than everyone else. That was all just nonse. Leaders just had to take initiative in a vacuum and wait for everyone else to fall in line, just like they always did.
Doris nodded. April nodded.
And Archer nodded back. “Good,” he said. “20 minutes. I’ll see you there.”
-o-
Sweeping out of the exam room was a dramatic turn, but Archer couldn’t deny that he was starting to feel a little anxious about this plan. No one questioned him as he charged out of the ED, going for the stairs and taking them two at a time up to the surgical floor. Archer had sway over nurses -- this much was true -- but Abrams was going to be a different animal.
Assuming Archer could ramrod Halstead through CT. Assuming the surgical staff accepted his insistence that they prep an OR without proper documentation. Assuming Halstead didn’t die on the way.
Assuming all that, Abrams was still going to be a pain in Archer’s ass.
No doubt, Abrams was one of the better doctors in this hospital, though Archer didn’t think that was an especially difficult task as he had met most of the doctors here. Still, Abrams knew his own value a little too well, and it made him a prick more often than not. He didn’t have much of a stomach for pretentious assholes, which was why he only subjected himself to Abrams’ insufferable demeanor when absolutely necessary.
Unfortunately, it was necessary now, and Archer was too aware that he was coming at this from a deficit. He preferred a position of power when asking for favors, but the fact was, he didn’t have one. He could only appeal to Abrams’ vanity and the slim possibility that he also harbored some ridiculous fondness for Halstead. If not fondness, then some modicum of respect.
That was asking a lot -- because Archer knew Halstead -- but still. The social dynamic in this place never ceased to defy logic. It annoyed him, but it was the only point of leverage he had left since his sucker punch landed so damn hard.
This whole thing required a series of perfect little things to fall in line.
Pushing Halstead through the CT line and clearing the path to surgery was one thing -- but it certainly wasn’t the only thing. No, Archer had reserved the most difficult task for himself.
Quite simply, he didn’t trust anyone else to pull it off.
Halstead’s survival was his survival at this point, so Archer wasn’t taking any chances.
And he wasn’t scared of anyone or anything, Archer wanted to make that very clear. All the same, the impending confrontation wasn’t one he relished. He’d wanted to take on Sam Abrams for awhile, that much was true. But he would have preferred to play on a level playing field. Archer was the one asking for a favor now, and it was going to be tough to spin that into a position of power.
Still, Archer wasn’t a quitter.
He was going to try.
In the surgical ward, he quickly noted the room assignments and skipped the desk. Instead, he went straight to the room, entering into the gallery without invitation. From a quick glance, it was easy to see that the operation was well underway. In fact, Archer knew just enough about brain surgery to see that Abrams was almost done.
Wishful thinking, maybe, but there had to be a few lucky breaks today. Deep in concentration, there was no way the surgical team was going to see him. The circulating nurse, however, met his eye and ducked out of the room and making her way into the gallery.
“Can I help you?” she asked, and she almost sounded helpful.
They would see just how helpful she was.
“I need Dr. Abrams,” he said, inclining his head to the operating room visible through the window. He smiled as he added all due inflection. “Now.”
She looked competent, but the nurse didn’t seem to catch the full meaning of what he was saying. Instead, she deferred to the party line. “As you can see, Dr. Abrams is in surgery right now. This isn’t a good time for a consult.”
“This isn’t a consult, and I know for a fact that Dr. Abrams is not in the middle of a surgery, but the end of one,” Archer said. “So, I really don’t want to hear your excuses, but I do want to see you going to get him.”
To be fair, she didn’t waffle like he might have hoped -- or expected. There was something to that -- Dr. Abrams was an insufferable asshole, but he was one of the few people here that knew how to run his staff -- and Archer might be impressed were he not so damn annoyed at the tedium while Halstead continued to bleed into his skull.
“Closing is not the same thing as done,” she said, and her smile took on a saccharine quality now. “I’m sure you can understand just how delicate and important the closing process is, and Dr. Abrams is very particular.”
“Yeah, that’s all well and good,” Archer said. “But the case I have is one he will want -- trust me.”
She was looking increasingly unimpressed -- her smile had faded completely by now. “If you just wait thirty minutes -- maybe an hour--”
The utter lack of respect was almost funny, but this day was getting too long, too annoying, too everything. Archer couldn’t find his smile now, not even for the most sarcastic reasons. “No, now way,” he said. He stared her down as hard as he could. “Get him now.”
She squared her shoulders, ready to stand her ground. “Dr. Abrams--”
The party line wasn’t going to save her now -- and it wasn’t going to save Halstead either. Archer stepped forward, eyes like ice, as he told her in no uncertain terms what he expected right now. “Tell Dr. Abrams to get his ass out here -- now,” he said. “And if he still objects after the consults, I’ll pay his fees for this surgery myself.”
Her lips drew into a line, marred with disgust and disdain. However, she at least knew her place. She was a nurse. He was an attending. No, he was the head of the damn ED. Of course she knew her place.
“Okay,” she said, regarding him coolly now. “But he’s not going to be very happy.”
“Well, I’m not very happy either,” he snarked at her. “So he may as well join the club today.”
-o-
All his bravado aside, Archer was aware of just how precarious the situation was -- for him and for Halstead. He could talk big and make stark demands, but this wasn’t something he could accomplish on his own. He needed Abrams on board -- and he needed him on board fast.
Archer paced back and forth, trying not to think of the weight of each second. He had tried to remain in control during this whole ordeal, but he could still feel his fingers tingling. This was his fault, was the thing. This was his fault.
He had to fix it.
He was trying to fix it.
He closed his eyes, breathing through the spike in anxiety.
He was going to fix it.
The tendrils of panic threatened to take hold in the pit of his gut, and he could feel the anxiety as it coiled in his lungs. His breathing quickened; his heart rate increased. Sweaty forehead, clammy palms -- Archer wasn’t going to lose control.
He just wasn’t.
The would-be panic attack was subverted, though, when he felt his iPad buzz. He glanced at it, eager for the fresh notification.
Especially this particular notification.
Halstead’s scan was up.
April and Doris had come through on at least that much, then. Clicking through the approval, Archer let it load in the file, rotating the device to get a closer and better look.
It didn’t really matter. Nuance and detail were not required to understand the scans.
Massive hemorrhage. Not from the punch, but from the impact with the counter and floor. Located in the back of the head, in the cerebellum. The diffuse matter had spread, though, involving nearly the entire brain. They needed to evacuate the blood quickly. They were up against the clock -- even more so than Archer had realized.
The chart updated again.
Halstead had been moved to pre-op with surgery scheduled with Dr. Abrams right now.
That was good.
Now, Archer just had to get Dr. Abrams to agree.
As if nearly on cue, Abrams came storming out of the OR. The door banged into the hallway, and the neurosurgeon rounded on him with spite and vengeance. “Who the hell do you think you are?” he asked without pretense. “I almost ignored you as I would be well within my rights.”
This was something of a power play. Archer would have resisted it on principle alone, but this time, he had good reason to dig in his heels. “Hold your horses and listen. This is important.”
Face pinched so hard that it looked literally painful, Abrams glared at him. “I will give you one chance here, or I will file a complaint against your unprofessional and, frankly, annoying behavior.”
If Abrams wanted to go personal, then Archer had the luxury of the high road for the moment. How he got there was not important. “It’s not for me. It’s a patient.”
Abrams did not look impressed. “It’s always a patient,” he snapped. “And I just left mine, so you better have something good for this utter lack of respect and the complete disregard for protocol. Don’t even get me started on your smug stupidity.”
“Look, I don’t care about your bitching and moaning,” Archer said. “They said you were closing, and I know that Evans is just a resident, but she’ll handle it just fine.”
Abrams looked nearly apoplectic. Their working relationship had been tense, to say the least, and Archer knew that while he could boss anyone around the ED, he would have to hold his own against a guy like Abrams. “You think you can order me around?” the neurosurgeon asked, fully indignant. “You manage the ED -- not neurology.”
Archer held out the iPad, undeterred. “Exactly,” he said. “And right now I need the best neurosurgeon in Chicago or this patient is never waking up again.”
With a moment of reluctance, Abrams eyed him. It wasn’t mere vanity that gave a man like Abrams pause, Archer knew it wasn’t that simple. No, it was curiosity. If Archer posed it as a challenge to him, then the other man would inevitably want to know more. He took the iPad and gave it a cursory look. Dispassionate though he was, it wasn’t hard to see him make the quick conclusion about the severity of the injury he was looking at. Halstead’s CT had revealed exactly what Archer expected: a massive brain bleed, hemorrhaging into his skull, putting pressure on his brain, increasing his odds of impairment or death with every passing second.
Archer had made the diagnosis without even seeing the scan.
Abrams took approximately five seconds to come to the exact same conclusion.
When he looked up, the anger was gone. Abrams regarded him with the cold diagnostics of a clinician. “Whose scans are these?” Abrams asked.
Archer stood his ground, because he’d staked out this position before Abrams had even known what was what. “Will Halstead.”
“No, the patient,” Abrams said tersely. “Who’s the patient?”
Archer had already girded himself to this truth. “Will Halstead,” he repeated, more staid this time. “Will Halstead is the patient.”
Sam Abrams was a conceited son of a bitch, but he at least had the decency to not mince words with protocol and smalltalk. His face registered a moment of surprise, but he quickly recovered to speak. “I’d ask what happened, but the more relevant question is when were these scans taken?”
Archer didn’t flinch. He couldn’t flinch. When you were that far in, you just had to keep going. “Five minutes ago.”
Abram’s expression pinched off even more, making it look like he’d sucked on a lemon. “He needs to be in surgery now.”
“He’s already being prepped,” Archer explained. “Just waiting for you.”
Abrams looked at scans again. His expression was grim, but he still nodded. “This could work.”
Archer didn’t do much with hope, but he knew Abrams well enough to know what he was capable of. Ethan could still walk because of this jackass, and he had to hope that Will Halstead wouldn’t be a damn turnip when this was done. And maybe, just maybe, Archer would still have a job. “You think we’re in time?”
Abrams looked at him coldly. “I think he has ten minutes -- tops -- before this bleed is catastrophic.”
Archer felt his stomach tighten, and the tendrils of panic threatened his collected demeanor. Friendly fire was just as deadly as an enemy combatant, but there were times when Archer couldn’t remember what the hell side he was even on anymore.
All he knew was that he couldn’t let Halstead die.
There were enough skeletons in his closet.
This was one he did not want.
“Then, you better get moving,” he said. “You need help?”
Abrams was already moving, lip curled as he glanced back. “Not from you.”
That one smarted more than Archer wanted to admit, but if this wasn’t about Abrams’ pride, then it couldn’t be about his own, either. It was his punch that started this, even if Halstead did have it coming. If Halstead died--
Well, that was a postulation Archer didn’t want to consider.
He was too old to start over.
He was too old for another stain on his conscience.
Hell, he just plain felt too old -- period.
“Fine,” he said. “Then you better get moving.”
