Chicago Med fic: Suckerpunched (3/10)
Dec. 23rd, 2021 04:51 pm![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
faye_dartmouthPART ONE
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
The surgery had been going for several hours. Surgery was always a somewhat protracted process -- another reason why ED work had better suited Archer from the start -- but even so. He’d mentally calculated the amount of time a normal brain surgery should take, and he was starting to get anxious that something had gone wrong.
When they wheeled Halstead through the doors, he felt the pressure in his chest unfurl a little bit. He was alive.
The nurses paid him no heed as they maneuvered the gurney toward the recovery bay, and Archer only spared Halstead one more look. He was still intubated -- obviously -- and his head had been heavily bandaged. No doubt, his skull was still open, but he had to start somewhere.
Letting the gurney pass, Archer turned back and waited for Abrams. The neurosurgeon was the next to exit. Although he had disposed of his gloves and mask, he was still gowned. Halstead’s blood speckled his front, and he looked less than pleased.
That would be off putting with any other doctor, but Abrams always looked like he was pissed off. There was only one way to know for sure.
“So?” Archer asked, intercepting him before he made it down the hall.
Abrams gave him a withering look, but he notably did not try to circumvent him. “I thought you’d gone back to work when I didn’t see you in the gallery any longer,” he mused wryly. “Don’t you have other patients?”
“Don’t you have something better to do than be an asshole?” Archer returned. “How did it go?”
“I’m just going to update the family,” Abrams said, not quite answering the question. “I was told the brother was here.”
“Yeah, lovely guy,” Archer muttered.
Abrams made a small face of indifference. “I’ve met him before. It was not under great circumstances as I did tell him his father was braindead. I’d like to be able to tell him something better this time, but false hope isn’t in my playbook.”
“But the surgery went well, didn’t it?” Archer asked with a sudden frown. As much as he’d love to commiserate over the misery that was Jay Halstead, the direness of the neurosurgeon’s tone caught him off guard.
“Well would have to be a relative description,” Abrams said. “I successfully located and stopped the bleeds, and he tolerated the surgery well, but that hardly means that he’s out of the woods.”
Archer let his frown deepen. “So, what’s the prognosis?”
“Honestly, I was hoping for better, but it could have been worse,” Abrams explained. He was normally unflappable, but Archer noticed he sounded notably weary. Even this asshole liked Halstead.
That was neither here nor there. Archer had to keep his focus. “But you said you got the bleeder? I mean, he can heal now, right? He’s at least on a path to recovery.”
Abrams made a small shrug, and Archer braced himself for inevitably tepid news. Success would have been broadcast loudly. Halstead wasn’t dead, but if Abrams wasn’t gloating, then there was another shoe to drop. “You know that these kinds of head wounds are tricky,” he said. “I did manage to close off the vessels doing the most damage, but that’s no guarantee they stay that way. With the way pressure is building in his head, he’s at high risk for another hemorrhage. You know that.”
“Sure,” Archer said, because he wasn’t some med school drop out here. He was head of the ED, and if he was worried that he’d just killed a guy on his staff, then he sure as hell wasn’t going to show it. “But the damage so far?”
“Does seem to be minimal,” Abrams said. “We got there fast. We were able to save the brain matter to a large degree. If we can keep the swelling under control, I’d say his odds are better than most.”
“So we keep the swelling down,” Archer said, matter of fact. “What meds?”
“The standard course, but there’s not much indication they’re working,” Abrams said, looking a little put off now. “I’ve also got a shunt in there for the time being, but I have strong concerns that it won’t be enough.”
Archer found himself scoffing. “I thought you said you did a good job,” he said. “This is sounding more and more like a hack job.”
Abrams didn’t rise to the bait, but his eyes did narrow. “It is only by my skill that he’s made it this far,” he snapped. “But brain injuries this severe -- surgeries this invasive -- they lead to their own problems. I’m watching him like a hawk. As soon as his ICP spikes, I will get him back in the OR for a decompressive craniectomy.”
That was not the news Archer wanted to hear. His goal had been to keep Halstead from dying, and here the neurosurgeon kept coming up with more invasive measures to prolong this entire debacle. “That’s a little drastic, don’t you think?”
Abrams looked less than impressed by the question. “It’s a procedure that has been shown to be quite effective in the right circumstances, but I don’t make the suggestion lightly,” he said tersely. “You do realize that he’s going to start losing brain matter if we can’t control the pressure. His body will only tolerate the pressure for so long.”
“But I thought you were the best neurosurgeon in the state,” Archer said pointedly. He wasn’t sure what fight he was trying to pick here, but he needed to get the best out of Abrams at the moment. Halstead had been a pain in his ass long enough. He’d wanted to get the man fired, but the last thing he needed was the red headed moron’s blood on his hands.
Halstead was an easy target.
Abrams, unfortunately, not so much. His dispassionate stare took on a vicious undertone. “The best in the region, thank you very much, quite possibly the country,” he said. “And I’ve told you. If not for the meticulous work I completed, Will Halstead would already be brain dead. At this point, the fact that he’s got any brain activity at all is nothing short of a miracle. What the hell happened to him anyway?”
Archer had been on the offensive, but the question put him on defense just that fast. He withdrew, easing his posture to deflect. “He got into a fight,” he said, keeping the words almost delicate as he said them.
The deflection was not wholly effective. Abrams seemed vexed by it. “In the hospital?”
Archer shrugged, using ambiguity and insinuation to his advantage. “He has been a little bit of a loose cannon lately.”
Ambiguity and insinuation were lost on a man like Abrams. “Sure, but his issues with medical ethics rarely turns into a punching match. We’re all professionals here, after all. Was it a patient?”
The deduction wasn’t a terrible one, and Archer kind of hated that. He’d never fully intended to use Halstead’s probationary status against him in this, but it was an awfully convenient excuse. Plausible, even. Hell, Goodwin hadn’t even balked. She’d all but helped him cement his story.
With the simple facts, there was no reason to suspect this was anything but a mistake on Halstead’s part.
But the emotions. The connections. The fact that people still liked him despite the fact that he was a bad excuse for a doctor -- that was a little infuriating.
And complicated.
Truth, though, had always been his greatest asset. He didn’t have to lie. He just had to tell a selected version of the truth.
It had worked for him so far, and here he was, head of the ED.
He squared his shoulders and looked Abrams in the eye. “No patient. It was me.”
There was a flicker of surprise in Abram’s expression, but it only lasted for a split second before all the pieces seemed to click into place. “Oh, I get it now. That’s what this is: you feel guilty.”
They clicked, all right. In all the wrong places. Archer screwed up his face and shook his head. “What? No -- that’s -- what are you even talking about?”
Abrams carried on anyway, disregarding his protest. “I mean, don’t get me wrong, I’ve wanted to slug him a time or two, but I’ve never actually done it.”
“Right,” Archer said sarcastically. “And what? You want me to believe that I’m too much of a professional?”
“No,” Abrams said with a little grunt of dissatisfaction. “I know my assets. My hands are far too valuable. Throwing punches is a dumb way to risk your career.”
Archer was in danger of blushing, so he preened instead. “Well, tell that to Halstead.”
Abrams didn’t miss a beat. “Hopefully, we can. Like I said, first I’ve got to get his condition stabilized.”
Now that the conversation was back on track, Archer felt okay about advancing it. “Well, I’ll help with the monitoring,” he said, conveniently neglecting to tell Abrams that the brother had kicked him off the case. If he was discreet, he could still play both sides of this fence. “Stay on the case. You know.”
The problem was that Abrams did know -- not about Archer’s lapse of protocol, but about his motives. He hadn’t put it together just yet -- that Will hadn’t been the one to start throwing punches -- but he seemed to have Archer’s motivations pegged. “You just admitted that you were the one who nearly killed him,” he said, unconvinced. “Accident or not, I feel like this could represent a conflict of interest for you.”
Archer had seen more action than anyone in this hospital, Ethan included. And they kept talking down to him, like he was some amater, like he was a child. Like he didn’t know more than they did. Like he couldn’t do it better.
The bureaucracy of it made him want to scream. If there hadn’t been so much blood and death in the military, he probably should have just stayed for all the trouble Chicago Med was worth.
“Look, what happened here -- this isn’t my fault,” he said, giving Abrams an unyielding look. He could be the best damn neurosurgeon in the world and Archer still wasn’t impressed. “Besides, there’s no conflict. Right? I’m looking to make sure Halstead stays alive, just like you. Incidentally, just like I’m sure Halstead wants.”
“Exactly,” Abrams said with infuriating calm. “That makes you reckless. You’re too invested here. We have to be doctors here, driven by facts and not emotion. If you’re trying to assuage your conscience--”
The assessment made Archer’s skin crawl. He balked on a laugh, caught half hysterical in his throat. He was really starting to hate this hospital. Abrams was just another son of a bitch, and he probably deserved a punch to the face even more than Halstead had.
The idea was tempting, but Archer had to admit it wasn’t the best idea right now.
Self-control was the idea of the moment.
Because the moment was all he could guarantee.
His smile was almost farcical, and he shook his head in bemused disbelief. “You really have no idea what you’re talking about.”
Abrams raised his brows quizzically. “Don’t I? You watched the whole surgery. You’re hovering about trying to manage his care. Everyone knows you can’t stand the guy. What am I supposed to think it’s about?”
Archer was seriously reconsidering that self-control thing at the moment. He was wondering if Abrams could take a punch better than Halstead had, but knowing Archer’s luck, he might just knock the whole hospital staff at Med out.
“I saved his life,” Archer said, making sure the bastard understood what he was saying. “I was the one who got him the treatment he needed before he was a vegetable. Me -- and no one else. So excuse me if I want to see it through.”
Abrams turned his nose up at him. “For the record, I saved his life, but fine,” he said tersely. “Just remember who’s in charge.”
Still seething, Archer watched Abrams go. If he could only nearly kill one colleague at Med, Abrams might have been a better choice than Halstead, but no one was dying today. Not Abrams and his smug neurosurgeon ass. Not Halstead and his stupid red-headed earnestness.
That was all.
The bottom line. The final result. Ends and means, was all. Just ends and means.
-o-
Now that he’d gotten the official word, Archer did want to verify the facts for himself. He was pleased to see that, despite Maggie’s threats, he had not been pulled from the system on Halstead’s case. He still had full access to the files, and Abrams had already posted a very preliminary confirmation of the nurse’s report from the OR. Better still, the anesthesiologist had posted her report, offering a few key insights into Halstead’s condition -- at least at first blush.
He’d stayed stable during surgery. Oxygenation levels had remained at 100 percent. He was maintaining his heart function and his pressure with minimal therapeutics.
In other words, he was overwhelmingly stable.
After an intense, invasive surgery, that really was the first hurdle.
But it was only the first hurdle in this particular case.
All it really confirmed was that Halstead’s brainstem hadn’t been affected by the bleed -- and that they’d been fast enough to avoid many of the secondary complications that kill people during a cerebral event. What could not be noted, however, was the impact on Halstead’s brain long term.
In other words, there was still no way to know if the guy was a vegetable or not.
And the fact of the matter was, he really could be a vegetable. If not now, then in a day, when his brain swelled against his skull too long.
Abrams’ detailed notes would add more clarity into a few things, but those notes weren’t likely to be completed for some time yet -- whenever the hell Abrams got around to his charting. Until then, Archer wasn’t about to just twiddle his thumbs. He could go back down to the ED and see if he could get a little work in, but he knew that wouldn’t do much good. He wouldn’t get anything done with everyone peppering him with questions about Halstead -- questions, frankly, he didn’t want to answer. Moreover, questions that might start to erode the integrity of the narrative that Goodwin herself had been building on his behalf.
No, it was best if he kept himself scarce.
Besides, he really wanted to see Halstead with his own two eyes. He could examine him for his own benefit, and that might allay some of the unresolved anxieties he had about this whole stupid situation.
He knew he had plenty of jurisdiction to make the rounds on Halstead, but he would have to be mindful -- both of Maggie and of the ridiculous Halstead brother she seemed to be babying. It was clear that Maggie had kept the request to remove him from the case off the books for the time being -- as made clear by his access to the charts -- but if he started making too much of a show in recovery, he was going to elicit unwanted attention.
Still, recovery was his best bet. That was a restricted ward with strict protocols. Family was not allowed in recovery.
However, as he rounded into the ward, he quickly realized he’d been too quick to make assumptions. Maggie was there with the brother -- clearly, making an exception to the very rules she’d been so stuck on earlier.
Hoping to avoid conflict -- he’d already punched out one Halstead and been punched by the other today -- he ducked out of the way, moving into one of the different patient bays. The nurse there gave him a funny look, but Archer picked up his iPad and started to log in. “Just following up,” he said with a smile to her.
She looked unconvinced, but he was an attending -- interim chief, thank you very much -- and she wasn’t. She left with nothing but a skeptical glance.
Archer stopped short, having nothing to press on the iPad once he’d logged in. He gave the patient a look and shrugged -- he’d never seen the guy -- but whatever. He made his way around the bed, standing at an angle to the open door. From here, he could make out the ward clearly, and he could see the opening where Maggie had taken the brother.
Initially, he might have hoped that this was a quick visit, just to reassure the brother that Halstead was alive, but a minute passed and then two. Then, Maggie left the room without the brother, and Archer came to the annoying conclusion that he had been permitted to hunker down. Hold a vigil -- whatever.
Surely Maggie thought she was being kind, but Archer had his doubts. What good was it for some novice off the street to sit by a bedside? The guy would clearly have no idea what was what. The whole thing was an exercise in futility. Archer wanted to be proactive in monitoring Halstead’s condition, looking for the slightest indication of change. That would be the only way to preempt potential problems -- the kind that could kill Halstead.
But no, he was going to be relegated to a side role, and for what? For some idiot brother to cling to Halstead’s hand and worry?
It seemed ridiculous.
It was ridiculous.
If he thought he could get away with it, he would have put a stop to the whole thing, but his story was being propped up by Goodwin’s good will. He couldn’t make any play to jeopardize that.
That said, he wasn’t going to make a play to jeopardize Halstead either.
Obviously, from a distance, he couldn’t track any changes in his vitals or ICP, but this was better than nothing. From here, he could see the comings and goings. The instant anything changed the entire setting, Archer would be on hand to make sure things were resolved appropriately.
Preferably without further head injuries.
Abrams had pegged it as guilt, but that was the dumbest thing yet. This had been an accident -- a fluke. A single punch should never have caused this much damage -- and if Halstead had been an acceptable attending, then none of it would have even escalated. And really, Goodwin never should have allowed him back on the staff.
This whole thing -- all of it -- was a comedy of errors.
A tragic comedy, but a comedy nonetheless.
With his decision to stay more or less cemented, he snagged a chair and sat down. The recovery area was compact for a reason with minimal efforts made toward privacy and no significant space for visitors. He was lucky he’d found a chair at all. Whoever this guy was, apparently he’d warranted some attention from someone.
He glanced over at the man, considering him once more. He was younger than Archer probably, but not by much. Overweight somewhat, balding -- the bandages suggest some kind of chest surgery. Heart? Lungs?
Who knew?
Well, someone knew.
And it occurred to him that if he was going to sit there, it might as well be him. The revelation came a bit late, however. The nurse came back in for her regular check. When she saw him still there, her look was funny.
“Can I help you, Dr….?”
“Archer,” he said quickly, straightening up with a sense of purpose he didn’t really have. “Dr. Archer.”
Her brow furrowed. “Aren’t you supposed to be in the ED?”
So his reputation had preceded him. This honestly made him feel a little bit better about today.
But now was not the time to preen. “No, I’m supposed to be here,” he said. He gestured to the man. “I’m closely monitoring this patient.”
It was not quite technically a lie. As he was in the room, watching the patient, his classification of the events could be considered entirely accurate -- if somewhat misleading.
This particular nurse seemed to sense just how misleading it was. “But you’re not on his case,” she said. “This is Latham’s patient. He’s had one of the residents rounding on him, hopefully to clear him soon. So, like, this is a little weird.”
“Weird?” Archer asked, effectively feigning offense now. “How is advanced patient care weird? Shouldn’t all doctors be this invested in the outcome of their patients?”
He was trying to stoke outrage, but her quizzical look deepened. “But -- you’re not on the case--”
“I’m the chief of the ED, and I’ve got a personal interest in this case which I do not have the desire much less the need to disclose to you,” he said. “I will continue to go above and beyond as I deem necessary, unless you have a problem with patients receiving the best care in this hospital?”
Her forehead was wrinkled, but she shrugged. “I guess not,” she said. “Just...let me know if you need anything.”
The offer was lackluster, but she wasn’t actually his problem -- and with even a moderately deferential attitude, she wouldn’t be an attitude. “I will,” he said, like he was doing her a favor by not pressing the matter of her obvious insubordination further. “And I would appreciate some privacy. This man is recovering from surgery.”
She gave him one more funny look but checked a few things, recorded the vitals to her chart, and made her way back out.
The trick to getting your way was to simply convince everyone else that they wanted what you wanted. Technically, people called it gaslighting, but Archer just considered it smart operational practice. It wasn’t his fault that most people were stupid enough to fall for it.
Passing the time wasn’t particularly easy with this lie, however. You could manipulate people into doing what you wanted, but it was a hell of a lot harder to coerce time into moving faster. Time had always been a problem for Archer. He had too much, too little -- never the right amount. Good moments were fleeting. The bad stuff dragged.
And today, this was the bad stuff.
In truth, his knuckles were still sore from contact with Halstead’s face. He rubbed his thumb over them absently, wondering how something so simple had gotten so complicated. Getting what he wanted wasn’t supposed to be this hard. He’d just needed to get the ED in shape. He’d just wanted to use his time and influence as best he could.
And this--
He sighed, letting his hands drop again as he watched out the curtain.
This wasn’t supposed to happen.
He was having a bad day, then.
He didn’t want to think about how Halstead might actually be having a worse one. At least he got to be unconscious for the worst of it, though. If the worst came to worse, then Halstead would never know. Maybe there were times when ignorance could be bliss.
Not for anyone else, of course.
It would break the back of the ED. He’d probably need to get a restraining order on the brother.
Not that it would matter.
Archer didn’t need another thing on his conscience.
He was so invested in this line of thought that he was taken by surprise when Abrams himself made the rounds. He made a beeline to Halstead’s room, which was a little odd. Residents tended to do the grunt work. He’d seen no sign that a code had been called or any action to indicate that a surgeon would be needed to consult.
No, Abrams was here because he wanted to clear Halstead himself.
And to think, Abrams had called him out on his investment.
The asshole was just as invested as Archer himself was.
Archer at least had a professional investment. Abrams, for all that he played the hard ass, just had the same idiotic soft spot for the red head as the rest of the staff. Halstead surely had some superpower to make him likeable when he was so damn stupid all the time.
As it was, Archer had a good view of the action, watching as Abrams conducted the transfer to ICU. This meant that Halstead was stable enough to be moved. Though there was certainly no way to gauge his prognosis this close to brain surgery, the measurable improvement was the best they could hope for. Most patients with a bleed of that severity were dead by now. Halstead had already beaten the worst of the odds.
Still, watching as he was wheeled out of the recovery ward, it was hard to think of him as lucky. Ventilated, transfused, catheter, feeding tube, open skull. Halstead probably didn’t have any brain activity yet, assuming he ever regained some.
Archer could work his ass off to keep Halstead alive, and he would, too, but there was nothing he could do about brain activity. Either the guy was going to have it or he wasn’t, and they all had to wait to find out.
With Halstead on the move, Archer slipped out after him. The nurse gave him a funny look, but Archer assured her that the patient was stable. Then, he told her to keep up the good work for good measure. Most people took random praise for what it was, but she still seemed perplexed.
Whatever.
Archer didn’t plan on being back in recovery for quite some time. One weirded-out nurse was truly the least of his concerns.
Instead, he focused on navigating back route to the ICU, doing his best to remain circumspect. At the very least, he had to stay out of the line of sight of Halstead’s brother and Maggie. Checking on patients in ICU was at least more natural for an ED doc, and he found he actually knew one or two of the patients to make his ploy more buyable. He’d treated one of them for a gunshot wound. The other had presented with a heart attack. He spent time pointlessly charting for both patients, asking questions of the nurses while he kept a keen eye on the private area being prepared for Halstead down the way.
Patient transfers were never as simple as getting from point A to point B. You had to transfer equipment and medication, and when patients were hooked up to as many things as Halstead, it was even more complicated. The process was somehow chaotic and tedious all at once, and for someone who didn’t understand the process, he could imagine it would also be quite overwhelming.
Abrams stayed to manage the baseline in the ICU, and the brother seemed to take a cue to stand out of the way. More than that, Archer observed with some relief, the weight of the ordeal seemed to be too much. Digging his phone out of his pocket, he said a few words to Maggie and made a quick hard turn, marching blindly back out of the ward even more quickly than he’d come.
Surely, he’d be back -- brother loyalty and whatnot -- but the look on his face was one Archer had seen before. This guy needed time to get his bearings. And, given the severity of Halstead’s condition and the extreme measures being used to keep him alive, that was going to take some time.
Archer didn’t need to maintain a constant vigil, but he did want to verify Halstead’s condition and vet his treatment plan on his own. Abrams was good -- Archer could concede that much -- but his apparent sentimentality toward Halstead might lead him to make more conservative choices. That kind of thing could be the difference between actual recovery and something much less.
Archer needed to be a part of this, even if he was technically supposed to be involved.
With relief, he saw Maggie clear out next, gathering a long breath before presumably heading back down to the ED. She stopped at the desk, talking to the charge nurse. She probably wanted to be alerted of any changes or alarms.
That meant two obstacles were down.
There was just one to go.
Abrams was going to take the longest, clearly, but he was also the party Archer was least worried about. First of all, he had no idea that Archer had been asked of the case. Second of all, he was the neurosurgeon. The more active Abrams was in this case, the better shot Halstead had. Archer still couldn’t stand the guy, but he was able to see the endgame here.
Of course, it would be nice if Abrams wasn’t be quite so conscientious. He helped with every phase of the transfer, and from his vantage point at the desk -- doing charting, of course, always charting -- he could see as he fussed about, checking the leads and monitors, making sure the machines were set to the right settings.
Then, in the ultimate display of premature hope, Abrams performed a rudimentary neuro exam.
Halstead failed, naturally, showing no response to any kind of stimuli.
With a sigh, Abrams stepped back. Making a few notes to the nurse, he checked Halstead’s bandages and finally made his exit.
This was Archer’s chance. If he wanted to do more than review the chart -- and he did -- he was going to have to get in there. He needed a hands-on approach, a concept that wouldn’t have seemed so ironic had his fist not been the thing to start this.
Though to be fair, it hadn’t been his fist.
It had been Halstead’s smug little face and inexplicably affable Irish complexion. Too many people took a hands-off approach where Halstead was concerned, and Archer knew these results weren’t exactly what he’d been going for, but at least he was being proactive.
This would have gone a lot better if Halstead had just quit like Archer had wanted.
But they could get to that later.
After Archer made sure that the guy survived.
He knew his window of opportunity was limited here, but life’s rewards never came without risks. He’d always been keen to take what he wanted -- no, what he needed. He refused to be a doctor who was hobbled by directives or operating procedures. You didn’t save lives from a manual. You saved lives from being the best at what you did and not taking no for an answer.
To Halstead’s credit, he was good at the last half.
But not the first.
Fortunately for him, Archer was excellent at both.
Thus determined -- as he had been all morning -- Archer picked up his charts and made his way directly to the room. The nurse was just clearing out, and she gave him a cursory nod, and he pulled up Halstead’s file just as she left the area.
The ICU was somewhat more outfitted for visitors, though it certainly didn’t have the perks of a normal room. The name of the game was still intensive care here, but it was clear they were trying to make this place as accessible as possible for the brother with one of the more comfortable chairs and as much privacy as a room in the ICU could afford.
Those were perks, but it was hard to really classify them that way, and Archer knew it. And if he didn’t, all he had to do was look at Halstead.
He’d watched the surgery -- he’d seen more of Halstead’s blood and brain than he wanted to -- but now here he was. Face to face with the bane of his existence. The true damage of his actions this morning, laid bare in front of him.
He sighed. He’d come in here to confirm the details on the chart and to make additional assessments, but he found himself unable to proceed. As crappy as Archer felt, Halstead looked worse. Responsibility was a fickle thing, and Archer wanted no part of this guilt. It had been his punch, but there had been reasons he’d thrown it. Good reasons.
It was stupid really, how easy it was to be right and wrong at the same time.
Archer didn’t want the guilt, but there was no way to hide from the regret. That list was long, longer than Archer cared to own, and now this one sat at the top.
The lives he saved might never make up for the ones he’d taken, the ones he’d been so lax with. First, Ethan. Now, this.
He shook his head, snorting a little as he smiled ruefully. “You’re lucky I still have a conscience,” he said to Halstead. “Because trust me, it would have been easier to let you die. A lot easier.”
His smirk faded a little as he watched the rise and fall of Halstead’s chest, the machine still doing the hard work for him.
“Goodwin actually blames you, if you must know. And I didn’t even go have to throw you under the bus,” he continued, as smug as he dared, as if any of this made his actions more palatable. “So you know, you really are the only witness. Keeping you alive is by far the biggest risk I could take.”
It was true, of course. But Archer found the bravado taxing.
This whole thing was taxing, this job, this life, all of it. Maybe Archer should have retired after all. Then the ED would be a mess, but Ethan would be walking easy, and Halstead wouldn’t have a damn hole in his head.
He let his shoulders fall, tired as he was. He was just so damn tired.
He scrubbed his hand through his hair, almost feeling sheepish for it all now. “But that’s not what I’m going for, okay? Not really,” he said,and he started to explain it in a rush. “I'm not going to let you die. I want you fired, not dead. I know I’m an asshole, but I’m not a monster. I’m really not.”
His point was true, utterly so, but it wasn’t well taken, not with Halstead barely clinging to life in the bed in front of him.
He was saying a lot, but he knew he wasn’t saying the things that really mattered. All he was offering was equivocation and justification. That fickle responsibility, as plain as it was while still deflecting anything real.
That was how Archer lived.
That was how he survived.
He won’t apologize, then. Not for any of it.
He was sorry, though.
It was crazy how sorry he was.
He cleared his throat, voice a little smaller now. “For what it’s worth, I didn’t mean for this to happen. I mean you kind of deserved the punch, but no one deserves--“
He hesitated, looking around the room. As an experienced doctor, none of this was new to him. There was no novelty to it, but that just made it all the more sobering. He knew what each and every machine did. He could tell you why each medication was needed. And it all painted the same, grim picture: Halstead was critical.
After surgery, Halstead was still on a ventilator, having no spontaneous respiration. Moreover, the guy had a hole in his skull, continually draining fluid at a steady and insufficient rate. His hair had been buzzed away for the craniotomy, and the exposed skull was wrapped tight in an effort to keep the wound clean.
At this point, he was more dead than alive, and there was no indication that he was going to ever come back.
“--this,” he said, the sentiment concluding uncomfortably in the silence between them.
He’d done this, too. He could lie about it. He could cover it up. He could go with the assumptions that everyone made and throw Halstead under the bus. But that didn’t change the fact as Archer knew them, and he knew that no matter what responsibilities he skirted, this one was on him.
Just like Ethan’s injury was on him.
Just like all the decisions he’d made during the war -- they were on him, too.
There was a reason Archer couldn’t stand the imperfections in other people. They all reminded him too much of himself, and the last thing he wanted was an ED full of imperfect assholes who did things right as much as they did things wrong.
Somewhere, Goodwin was crafting a disciplinary response to fire Halstead if he ever recovered. Somewhere else, Jay Halstead was pacing himself into oblivion in a waiting room, waiting for news he wouldn’t want to hear. And downstairs, the whole ED held its breath while Halstead breathed through a tube.
And here was Archer.
Sitting himself in the middle of it all.
He looked at Halstead, as steady as he could. “You have my word, I'll get you through this, okay?” he said. “I’ll see you through to the other side.”
Archer didn’t have to like him, he didn’t have to be a good person.
He just had to be a doctor for now.
And Archer had been terrible at most everything else in his life, but he’d always been good at that.
PART TWO
PART THREE
PART FOUR
PART FIVE
PART SIX
PART SEVEN
PART EIGHT
PART NINE
PART TEN
-o-
The surgery had been going for several hours. Surgery was always a somewhat protracted process -- another reason why ED work had better suited Archer from the start -- but even so. He’d mentally calculated the amount of time a normal brain surgery should take, and he was starting to get anxious that something had gone wrong.
When they wheeled Halstead through the doors, he felt the pressure in his chest unfurl a little bit. He was alive.
The nurses paid him no heed as they maneuvered the gurney toward the recovery bay, and Archer only spared Halstead one more look. He was still intubated -- obviously -- and his head had been heavily bandaged. No doubt, his skull was still open, but he had to start somewhere.
Letting the gurney pass, Archer turned back and waited for Abrams. The neurosurgeon was the next to exit. Although he had disposed of his gloves and mask, he was still gowned. Halstead’s blood speckled his front, and he looked less than pleased.
That would be off putting with any other doctor, but Abrams always looked like he was pissed off. There was only one way to know for sure.
“So?” Archer asked, intercepting him before he made it down the hall.
Abrams gave him a withering look, but he notably did not try to circumvent him. “I thought you’d gone back to work when I didn’t see you in the gallery any longer,” he mused wryly. “Don’t you have other patients?”
“Don’t you have something better to do than be an asshole?” Archer returned. “How did it go?”
“I’m just going to update the family,” Abrams said, not quite answering the question. “I was told the brother was here.”
“Yeah, lovely guy,” Archer muttered.
Abrams made a small face of indifference. “I’ve met him before. It was not under great circumstances as I did tell him his father was braindead. I’d like to be able to tell him something better this time, but false hope isn’t in my playbook.”
“But the surgery went well, didn’t it?” Archer asked with a sudden frown. As much as he’d love to commiserate over the misery that was Jay Halstead, the direness of the neurosurgeon’s tone caught him off guard.
“Well would have to be a relative description,” Abrams said. “I successfully located and stopped the bleeds, and he tolerated the surgery well, but that hardly means that he’s out of the woods.”
Archer let his frown deepen. “So, what’s the prognosis?”
“Honestly, I was hoping for better, but it could have been worse,” Abrams explained. He was normally unflappable, but Archer noticed he sounded notably weary. Even this asshole liked Halstead.
That was neither here nor there. Archer had to keep his focus. “But you said you got the bleeder? I mean, he can heal now, right? He’s at least on a path to recovery.”
Abrams made a small shrug, and Archer braced himself for inevitably tepid news. Success would have been broadcast loudly. Halstead wasn’t dead, but if Abrams wasn’t gloating, then there was another shoe to drop. “You know that these kinds of head wounds are tricky,” he said. “I did manage to close off the vessels doing the most damage, but that’s no guarantee they stay that way. With the way pressure is building in his head, he’s at high risk for another hemorrhage. You know that.”
“Sure,” Archer said, because he wasn’t some med school drop out here. He was head of the ED, and if he was worried that he’d just killed a guy on his staff, then he sure as hell wasn’t going to show it. “But the damage so far?”
“Does seem to be minimal,” Abrams said. “We got there fast. We were able to save the brain matter to a large degree. If we can keep the swelling under control, I’d say his odds are better than most.”
“So we keep the swelling down,” Archer said, matter of fact. “What meds?”
“The standard course, but there’s not much indication they’re working,” Abrams said, looking a little put off now. “I’ve also got a shunt in there for the time being, but I have strong concerns that it won’t be enough.”
Archer found himself scoffing. “I thought you said you did a good job,” he said. “This is sounding more and more like a hack job.”
Abrams didn’t rise to the bait, but his eyes did narrow. “It is only by my skill that he’s made it this far,” he snapped. “But brain injuries this severe -- surgeries this invasive -- they lead to their own problems. I’m watching him like a hawk. As soon as his ICP spikes, I will get him back in the OR for a decompressive craniectomy.”
That was not the news Archer wanted to hear. His goal had been to keep Halstead from dying, and here the neurosurgeon kept coming up with more invasive measures to prolong this entire debacle. “That’s a little drastic, don’t you think?”
Abrams looked less than impressed by the question. “It’s a procedure that has been shown to be quite effective in the right circumstances, but I don’t make the suggestion lightly,” he said tersely. “You do realize that he’s going to start losing brain matter if we can’t control the pressure. His body will only tolerate the pressure for so long.”
“But I thought you were the best neurosurgeon in the state,” Archer said pointedly. He wasn’t sure what fight he was trying to pick here, but he needed to get the best out of Abrams at the moment. Halstead had been a pain in his ass long enough. He’d wanted to get the man fired, but the last thing he needed was the red headed moron’s blood on his hands.
Halstead was an easy target.
Abrams, unfortunately, not so much. His dispassionate stare took on a vicious undertone. “The best in the region, thank you very much, quite possibly the country,” he said. “And I’ve told you. If not for the meticulous work I completed, Will Halstead would already be brain dead. At this point, the fact that he’s got any brain activity at all is nothing short of a miracle. What the hell happened to him anyway?”
Archer had been on the offensive, but the question put him on defense just that fast. He withdrew, easing his posture to deflect. “He got into a fight,” he said, keeping the words almost delicate as he said them.
The deflection was not wholly effective. Abrams seemed vexed by it. “In the hospital?”
Archer shrugged, using ambiguity and insinuation to his advantage. “He has been a little bit of a loose cannon lately.”
Ambiguity and insinuation were lost on a man like Abrams. “Sure, but his issues with medical ethics rarely turns into a punching match. We’re all professionals here, after all. Was it a patient?”
The deduction wasn’t a terrible one, and Archer kind of hated that. He’d never fully intended to use Halstead’s probationary status against him in this, but it was an awfully convenient excuse. Plausible, even. Hell, Goodwin hadn’t even balked. She’d all but helped him cement his story.
With the simple facts, there was no reason to suspect this was anything but a mistake on Halstead’s part.
But the emotions. The connections. The fact that people still liked him despite the fact that he was a bad excuse for a doctor -- that was a little infuriating.
And complicated.
Truth, though, had always been his greatest asset. He didn’t have to lie. He just had to tell a selected version of the truth.
It had worked for him so far, and here he was, head of the ED.
He squared his shoulders and looked Abrams in the eye. “No patient. It was me.”
There was a flicker of surprise in Abram’s expression, but it only lasted for a split second before all the pieces seemed to click into place. “Oh, I get it now. That’s what this is: you feel guilty.”
They clicked, all right. In all the wrong places. Archer screwed up his face and shook his head. “What? No -- that’s -- what are you even talking about?”
Abrams carried on anyway, disregarding his protest. “I mean, don’t get me wrong, I’ve wanted to slug him a time or two, but I’ve never actually done it.”
“Right,” Archer said sarcastically. “And what? You want me to believe that I’m too much of a professional?”
“No,” Abrams said with a little grunt of dissatisfaction. “I know my assets. My hands are far too valuable. Throwing punches is a dumb way to risk your career.”
Archer was in danger of blushing, so he preened instead. “Well, tell that to Halstead.”
Abrams didn’t miss a beat. “Hopefully, we can. Like I said, first I’ve got to get his condition stabilized.”
Now that the conversation was back on track, Archer felt okay about advancing it. “Well, I’ll help with the monitoring,” he said, conveniently neglecting to tell Abrams that the brother had kicked him off the case. If he was discreet, he could still play both sides of this fence. “Stay on the case. You know.”
The problem was that Abrams did know -- not about Archer’s lapse of protocol, but about his motives. He hadn’t put it together just yet -- that Will hadn’t been the one to start throwing punches -- but he seemed to have Archer’s motivations pegged. “You just admitted that you were the one who nearly killed him,” he said, unconvinced. “Accident or not, I feel like this could represent a conflict of interest for you.”
Archer had seen more action than anyone in this hospital, Ethan included. And they kept talking down to him, like he was some amater, like he was a child. Like he didn’t know more than they did. Like he couldn’t do it better.
The bureaucracy of it made him want to scream. If there hadn’t been so much blood and death in the military, he probably should have just stayed for all the trouble Chicago Med was worth.
“Look, what happened here -- this isn’t my fault,” he said, giving Abrams an unyielding look. He could be the best damn neurosurgeon in the world and Archer still wasn’t impressed. “Besides, there’s no conflict. Right? I’m looking to make sure Halstead stays alive, just like you. Incidentally, just like I’m sure Halstead wants.”
“Exactly,” Abrams said with infuriating calm. “That makes you reckless. You’re too invested here. We have to be doctors here, driven by facts and not emotion. If you’re trying to assuage your conscience--”
The assessment made Archer’s skin crawl. He balked on a laugh, caught half hysterical in his throat. He was really starting to hate this hospital. Abrams was just another son of a bitch, and he probably deserved a punch to the face even more than Halstead had.
The idea was tempting, but Archer had to admit it wasn’t the best idea right now.
Self-control was the idea of the moment.
Because the moment was all he could guarantee.
His smile was almost farcical, and he shook his head in bemused disbelief. “You really have no idea what you’re talking about.”
Abrams raised his brows quizzically. “Don’t I? You watched the whole surgery. You’re hovering about trying to manage his care. Everyone knows you can’t stand the guy. What am I supposed to think it’s about?”
Archer was seriously reconsidering that self-control thing at the moment. He was wondering if Abrams could take a punch better than Halstead had, but knowing Archer’s luck, he might just knock the whole hospital staff at Med out.
“I saved his life,” Archer said, making sure the bastard understood what he was saying. “I was the one who got him the treatment he needed before he was a vegetable. Me -- and no one else. So excuse me if I want to see it through.”
Abrams turned his nose up at him. “For the record, I saved his life, but fine,” he said tersely. “Just remember who’s in charge.”
Still seething, Archer watched Abrams go. If he could only nearly kill one colleague at Med, Abrams might have been a better choice than Halstead, but no one was dying today. Not Abrams and his smug neurosurgeon ass. Not Halstead and his stupid red-headed earnestness.
That was all.
The bottom line. The final result. Ends and means, was all. Just ends and means.
-o-
Now that he’d gotten the official word, Archer did want to verify the facts for himself. He was pleased to see that, despite Maggie’s threats, he had not been pulled from the system on Halstead’s case. He still had full access to the files, and Abrams had already posted a very preliminary confirmation of the nurse’s report from the OR. Better still, the anesthesiologist had posted her report, offering a few key insights into Halstead’s condition -- at least at first blush.
He’d stayed stable during surgery. Oxygenation levels had remained at 100 percent. He was maintaining his heart function and his pressure with minimal therapeutics.
In other words, he was overwhelmingly stable.
After an intense, invasive surgery, that really was the first hurdle.
But it was only the first hurdle in this particular case.
All it really confirmed was that Halstead’s brainstem hadn’t been affected by the bleed -- and that they’d been fast enough to avoid many of the secondary complications that kill people during a cerebral event. What could not be noted, however, was the impact on Halstead’s brain long term.
In other words, there was still no way to know if the guy was a vegetable or not.
And the fact of the matter was, he really could be a vegetable. If not now, then in a day, when his brain swelled against his skull too long.
Abrams’ detailed notes would add more clarity into a few things, but those notes weren’t likely to be completed for some time yet -- whenever the hell Abrams got around to his charting. Until then, Archer wasn’t about to just twiddle his thumbs. He could go back down to the ED and see if he could get a little work in, but he knew that wouldn’t do much good. He wouldn’t get anything done with everyone peppering him with questions about Halstead -- questions, frankly, he didn’t want to answer. Moreover, questions that might start to erode the integrity of the narrative that Goodwin herself had been building on his behalf.
No, it was best if he kept himself scarce.
Besides, he really wanted to see Halstead with his own two eyes. He could examine him for his own benefit, and that might allay some of the unresolved anxieties he had about this whole stupid situation.
He knew he had plenty of jurisdiction to make the rounds on Halstead, but he would have to be mindful -- both of Maggie and of the ridiculous Halstead brother she seemed to be babying. It was clear that Maggie had kept the request to remove him from the case off the books for the time being -- as made clear by his access to the charts -- but if he started making too much of a show in recovery, he was going to elicit unwanted attention.
Still, recovery was his best bet. That was a restricted ward with strict protocols. Family was not allowed in recovery.
However, as he rounded into the ward, he quickly realized he’d been too quick to make assumptions. Maggie was there with the brother -- clearly, making an exception to the very rules she’d been so stuck on earlier.
Hoping to avoid conflict -- he’d already punched out one Halstead and been punched by the other today -- he ducked out of the way, moving into one of the different patient bays. The nurse there gave him a funny look, but Archer picked up his iPad and started to log in. “Just following up,” he said with a smile to her.
She looked unconvinced, but he was an attending -- interim chief, thank you very much -- and she wasn’t. She left with nothing but a skeptical glance.
Archer stopped short, having nothing to press on the iPad once he’d logged in. He gave the patient a look and shrugged -- he’d never seen the guy -- but whatever. He made his way around the bed, standing at an angle to the open door. From here, he could make out the ward clearly, and he could see the opening where Maggie had taken the brother.
Initially, he might have hoped that this was a quick visit, just to reassure the brother that Halstead was alive, but a minute passed and then two. Then, Maggie left the room without the brother, and Archer came to the annoying conclusion that he had been permitted to hunker down. Hold a vigil -- whatever.
Surely Maggie thought she was being kind, but Archer had his doubts. What good was it for some novice off the street to sit by a bedside? The guy would clearly have no idea what was what. The whole thing was an exercise in futility. Archer wanted to be proactive in monitoring Halstead’s condition, looking for the slightest indication of change. That would be the only way to preempt potential problems -- the kind that could kill Halstead.
But no, he was going to be relegated to a side role, and for what? For some idiot brother to cling to Halstead’s hand and worry?
It seemed ridiculous.
It was ridiculous.
If he thought he could get away with it, he would have put a stop to the whole thing, but his story was being propped up by Goodwin’s good will. He couldn’t make any play to jeopardize that.
That said, he wasn’t going to make a play to jeopardize Halstead either.
Obviously, from a distance, he couldn’t track any changes in his vitals or ICP, but this was better than nothing. From here, he could see the comings and goings. The instant anything changed the entire setting, Archer would be on hand to make sure things were resolved appropriately.
Preferably without further head injuries.
Abrams had pegged it as guilt, but that was the dumbest thing yet. This had been an accident -- a fluke. A single punch should never have caused this much damage -- and if Halstead had been an acceptable attending, then none of it would have even escalated. And really, Goodwin never should have allowed him back on the staff.
This whole thing -- all of it -- was a comedy of errors.
A tragic comedy, but a comedy nonetheless.
With his decision to stay more or less cemented, he snagged a chair and sat down. The recovery area was compact for a reason with minimal efforts made toward privacy and no significant space for visitors. He was lucky he’d found a chair at all. Whoever this guy was, apparently he’d warranted some attention from someone.
He glanced over at the man, considering him once more. He was younger than Archer probably, but not by much. Overweight somewhat, balding -- the bandages suggest some kind of chest surgery. Heart? Lungs?
Who knew?
Well, someone knew.
And it occurred to him that if he was going to sit there, it might as well be him. The revelation came a bit late, however. The nurse came back in for her regular check. When she saw him still there, her look was funny.
“Can I help you, Dr….?”
“Archer,” he said quickly, straightening up with a sense of purpose he didn’t really have. “Dr. Archer.”
Her brow furrowed. “Aren’t you supposed to be in the ED?”
So his reputation had preceded him. This honestly made him feel a little bit better about today.
But now was not the time to preen. “No, I’m supposed to be here,” he said. He gestured to the man. “I’m closely monitoring this patient.”
It was not quite technically a lie. As he was in the room, watching the patient, his classification of the events could be considered entirely accurate -- if somewhat misleading.
This particular nurse seemed to sense just how misleading it was. “But you’re not on his case,” she said. “This is Latham’s patient. He’s had one of the residents rounding on him, hopefully to clear him soon. So, like, this is a little weird.”
“Weird?” Archer asked, effectively feigning offense now. “How is advanced patient care weird? Shouldn’t all doctors be this invested in the outcome of their patients?”
He was trying to stoke outrage, but her quizzical look deepened. “But -- you’re not on the case--”
“I’m the chief of the ED, and I’ve got a personal interest in this case which I do not have the desire much less the need to disclose to you,” he said. “I will continue to go above and beyond as I deem necessary, unless you have a problem with patients receiving the best care in this hospital?”
Her forehead was wrinkled, but she shrugged. “I guess not,” she said. “Just...let me know if you need anything.”
The offer was lackluster, but she wasn’t actually his problem -- and with even a moderately deferential attitude, she wouldn’t be an attitude. “I will,” he said, like he was doing her a favor by not pressing the matter of her obvious insubordination further. “And I would appreciate some privacy. This man is recovering from surgery.”
She gave him one more funny look but checked a few things, recorded the vitals to her chart, and made her way back out.
The trick to getting your way was to simply convince everyone else that they wanted what you wanted. Technically, people called it gaslighting, but Archer just considered it smart operational practice. It wasn’t his fault that most people were stupid enough to fall for it.
Passing the time wasn’t particularly easy with this lie, however. You could manipulate people into doing what you wanted, but it was a hell of a lot harder to coerce time into moving faster. Time had always been a problem for Archer. He had too much, too little -- never the right amount. Good moments were fleeting. The bad stuff dragged.
And today, this was the bad stuff.
In truth, his knuckles were still sore from contact with Halstead’s face. He rubbed his thumb over them absently, wondering how something so simple had gotten so complicated. Getting what he wanted wasn’t supposed to be this hard. He’d just needed to get the ED in shape. He’d just wanted to use his time and influence as best he could.
And this--
He sighed, letting his hands drop again as he watched out the curtain.
This wasn’t supposed to happen.
He was having a bad day, then.
He didn’t want to think about how Halstead might actually be having a worse one. At least he got to be unconscious for the worst of it, though. If the worst came to worse, then Halstead would never know. Maybe there were times when ignorance could be bliss.
Not for anyone else, of course.
It would break the back of the ED. He’d probably need to get a restraining order on the brother.
Not that it would matter.
Archer didn’t need another thing on his conscience.
He was so invested in this line of thought that he was taken by surprise when Abrams himself made the rounds. He made a beeline to Halstead’s room, which was a little odd. Residents tended to do the grunt work. He’d seen no sign that a code had been called or any action to indicate that a surgeon would be needed to consult.
No, Abrams was here because he wanted to clear Halstead himself.
And to think, Abrams had called him out on his investment.
The asshole was just as invested as Archer himself was.
Archer at least had a professional investment. Abrams, for all that he played the hard ass, just had the same idiotic soft spot for the red head as the rest of the staff. Halstead surely had some superpower to make him likeable when he was so damn stupid all the time.
As it was, Archer had a good view of the action, watching as Abrams conducted the transfer to ICU. This meant that Halstead was stable enough to be moved. Though there was certainly no way to gauge his prognosis this close to brain surgery, the measurable improvement was the best they could hope for. Most patients with a bleed of that severity were dead by now. Halstead had already beaten the worst of the odds.
Still, watching as he was wheeled out of the recovery ward, it was hard to think of him as lucky. Ventilated, transfused, catheter, feeding tube, open skull. Halstead probably didn’t have any brain activity yet, assuming he ever regained some.
Archer could work his ass off to keep Halstead alive, and he would, too, but there was nothing he could do about brain activity. Either the guy was going to have it or he wasn’t, and they all had to wait to find out.
With Halstead on the move, Archer slipped out after him. The nurse gave him a funny look, but Archer assured her that the patient was stable. Then, he told her to keep up the good work for good measure. Most people took random praise for what it was, but she still seemed perplexed.
Whatever.
Archer didn’t plan on being back in recovery for quite some time. One weirded-out nurse was truly the least of his concerns.
Instead, he focused on navigating back route to the ICU, doing his best to remain circumspect. At the very least, he had to stay out of the line of sight of Halstead’s brother and Maggie. Checking on patients in ICU was at least more natural for an ED doc, and he found he actually knew one or two of the patients to make his ploy more buyable. He’d treated one of them for a gunshot wound. The other had presented with a heart attack. He spent time pointlessly charting for both patients, asking questions of the nurses while he kept a keen eye on the private area being prepared for Halstead down the way.
Patient transfers were never as simple as getting from point A to point B. You had to transfer equipment and medication, and when patients were hooked up to as many things as Halstead, it was even more complicated. The process was somehow chaotic and tedious all at once, and for someone who didn’t understand the process, he could imagine it would also be quite overwhelming.
Abrams stayed to manage the baseline in the ICU, and the brother seemed to take a cue to stand out of the way. More than that, Archer observed with some relief, the weight of the ordeal seemed to be too much. Digging his phone out of his pocket, he said a few words to Maggie and made a quick hard turn, marching blindly back out of the ward even more quickly than he’d come.
Surely, he’d be back -- brother loyalty and whatnot -- but the look on his face was one Archer had seen before. This guy needed time to get his bearings. And, given the severity of Halstead’s condition and the extreme measures being used to keep him alive, that was going to take some time.
Archer didn’t need to maintain a constant vigil, but he did want to verify Halstead’s condition and vet his treatment plan on his own. Abrams was good -- Archer could concede that much -- but his apparent sentimentality toward Halstead might lead him to make more conservative choices. That kind of thing could be the difference between actual recovery and something much less.
Archer needed to be a part of this, even if he was technically supposed to be involved.
With relief, he saw Maggie clear out next, gathering a long breath before presumably heading back down to the ED. She stopped at the desk, talking to the charge nurse. She probably wanted to be alerted of any changes or alarms.
That meant two obstacles were down.
There was just one to go.
Abrams was going to take the longest, clearly, but he was also the party Archer was least worried about. First of all, he had no idea that Archer had been asked of the case. Second of all, he was the neurosurgeon. The more active Abrams was in this case, the better shot Halstead had. Archer still couldn’t stand the guy, but he was able to see the endgame here.
Of course, it would be nice if Abrams wasn’t be quite so conscientious. He helped with every phase of the transfer, and from his vantage point at the desk -- doing charting, of course, always charting -- he could see as he fussed about, checking the leads and monitors, making sure the machines were set to the right settings.
Then, in the ultimate display of premature hope, Abrams performed a rudimentary neuro exam.
Halstead failed, naturally, showing no response to any kind of stimuli.
With a sigh, Abrams stepped back. Making a few notes to the nurse, he checked Halstead’s bandages and finally made his exit.
This was Archer’s chance. If he wanted to do more than review the chart -- and he did -- he was going to have to get in there. He needed a hands-on approach, a concept that wouldn’t have seemed so ironic had his fist not been the thing to start this.
Though to be fair, it hadn’t been his fist.
It had been Halstead’s smug little face and inexplicably affable Irish complexion. Too many people took a hands-off approach where Halstead was concerned, and Archer knew these results weren’t exactly what he’d been going for, but at least he was being proactive.
This would have gone a lot better if Halstead had just quit like Archer had wanted.
But they could get to that later.
After Archer made sure that the guy survived.
He knew his window of opportunity was limited here, but life’s rewards never came without risks. He’d always been keen to take what he wanted -- no, what he needed. He refused to be a doctor who was hobbled by directives or operating procedures. You didn’t save lives from a manual. You saved lives from being the best at what you did and not taking no for an answer.
To Halstead’s credit, he was good at the last half.
But not the first.
Fortunately for him, Archer was excellent at both.
Thus determined -- as he had been all morning -- Archer picked up his charts and made his way directly to the room. The nurse was just clearing out, and she gave him a cursory nod, and he pulled up Halstead’s file just as she left the area.
The ICU was somewhat more outfitted for visitors, though it certainly didn’t have the perks of a normal room. The name of the game was still intensive care here, but it was clear they were trying to make this place as accessible as possible for the brother with one of the more comfortable chairs and as much privacy as a room in the ICU could afford.
Those were perks, but it was hard to really classify them that way, and Archer knew it. And if he didn’t, all he had to do was look at Halstead.
He’d watched the surgery -- he’d seen more of Halstead’s blood and brain than he wanted to -- but now here he was. Face to face with the bane of his existence. The true damage of his actions this morning, laid bare in front of him.
He sighed. He’d come in here to confirm the details on the chart and to make additional assessments, but he found himself unable to proceed. As crappy as Archer felt, Halstead looked worse. Responsibility was a fickle thing, and Archer wanted no part of this guilt. It had been his punch, but there had been reasons he’d thrown it. Good reasons.
It was stupid really, how easy it was to be right and wrong at the same time.
Archer didn’t want the guilt, but there was no way to hide from the regret. That list was long, longer than Archer cared to own, and now this one sat at the top.
The lives he saved might never make up for the ones he’d taken, the ones he’d been so lax with. First, Ethan. Now, this.
He shook his head, snorting a little as he smiled ruefully. “You’re lucky I still have a conscience,” he said to Halstead. “Because trust me, it would have been easier to let you die. A lot easier.”
His smirk faded a little as he watched the rise and fall of Halstead’s chest, the machine still doing the hard work for him.
“Goodwin actually blames you, if you must know. And I didn’t even go have to throw you under the bus,” he continued, as smug as he dared, as if any of this made his actions more palatable. “So you know, you really are the only witness. Keeping you alive is by far the biggest risk I could take.”
It was true, of course. But Archer found the bravado taxing.
This whole thing was taxing, this job, this life, all of it. Maybe Archer should have retired after all. Then the ED would be a mess, but Ethan would be walking easy, and Halstead wouldn’t have a damn hole in his head.
He let his shoulders fall, tired as he was. He was just so damn tired.
He scrubbed his hand through his hair, almost feeling sheepish for it all now. “But that’s not what I’m going for, okay? Not really,” he said,and he started to explain it in a rush. “I'm not going to let you die. I want you fired, not dead. I know I’m an asshole, but I’m not a monster. I’m really not.”
His point was true, utterly so, but it wasn’t well taken, not with Halstead barely clinging to life in the bed in front of him.
He was saying a lot, but he knew he wasn’t saying the things that really mattered. All he was offering was equivocation and justification. That fickle responsibility, as plain as it was while still deflecting anything real.
That was how Archer lived.
That was how he survived.
He won’t apologize, then. Not for any of it.
He was sorry, though.
It was crazy how sorry he was.
He cleared his throat, voice a little smaller now. “For what it’s worth, I didn’t mean for this to happen. I mean you kind of deserved the punch, but no one deserves--“
He hesitated, looking around the room. As an experienced doctor, none of this was new to him. There was no novelty to it, but that just made it all the more sobering. He knew what each and every machine did. He could tell you why each medication was needed. And it all painted the same, grim picture: Halstead was critical.
After surgery, Halstead was still on a ventilator, having no spontaneous respiration. Moreover, the guy had a hole in his skull, continually draining fluid at a steady and insufficient rate. His hair had been buzzed away for the craniotomy, and the exposed skull was wrapped tight in an effort to keep the wound clean.
At this point, he was more dead than alive, and there was no indication that he was going to ever come back.
“--this,” he said, the sentiment concluding uncomfortably in the silence between them.
He’d done this, too. He could lie about it. He could cover it up. He could go with the assumptions that everyone made and throw Halstead under the bus. But that didn’t change the fact as Archer knew them, and he knew that no matter what responsibilities he skirted, this one was on him.
Just like Ethan’s injury was on him.
Just like all the decisions he’d made during the war -- they were on him, too.
There was a reason Archer couldn’t stand the imperfections in other people. They all reminded him too much of himself, and the last thing he wanted was an ED full of imperfect assholes who did things right as much as they did things wrong.
Somewhere, Goodwin was crafting a disciplinary response to fire Halstead if he ever recovered. Somewhere else, Jay Halstead was pacing himself into oblivion in a waiting room, waiting for news he wouldn’t want to hear. And downstairs, the whole ED held its breath while Halstead breathed through a tube.
And here was Archer.
Sitting himself in the middle of it all.
He looked at Halstead, as steady as he could. “You have my word, I'll get you through this, okay?” he said. “I’ll see you through to the other side.”
Archer didn’t have to like him, he didn’t have to be a good person.
He just had to be a doctor for now.
And Archer had been terrible at most everything else in his life, but he’d always been good at that.
