#pediatric medical coding
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kathycare · 2 months ago
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mbc-medicalbillingcompany · 5 months ago
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This article outlines developmental screening guidelines for pediatricians, emphasizing accurate assessments, early diagnosis, and proper billing for screenings.
Contact number:-888-357-3226  
Email ID:- [email protected],
Click here to know more :- https://shorturl.at/eq5MQ
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medical-billing-service-0 · 9 months ago
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Streamline Your Practice with Pediatric Billing Services
Managing the financial aspects of a pediatric practice comes with its own set of unique challenges. Pediatric care often involves regular checkups, vaccinations, and varying insurance policies, making billing more complex. Medical billing services tailored to pediatric care ensure that healthcare providers are reimbursed accurately and on time. Streamlined billing services reduce administrative burdens, allowing pediatricians to focus on providing quality care to their patients, while efficiently managing their revenue cycle.
What Are Pediatric Billing Services?
Pediatric billing services cater specifically to the needs of pediatric healthcare providers. They encompass the management of medical billing and coding for pediatric treatments, office visits, and procedures. Pediatric billing services ensure accurate submission of insurance claims, utilizing industry-standard codes to document every service provided to children. With the right medical billing services, pediatric practices can eliminate common errors that lead to claim denials and ensure that payments are received promptly.
The Importance of RCM Services in Pediatric Billing
Revenue cycle management (RCM) services are integral to the financial health of any healthcare practice, including pediatric ones. Pediatricians often deal with a higher volume of claims due to frequent patient visits. Efficient RCM services ensure the smooth functioning of the billing process, from patient registration to claims submission and payment collection. Pediatric billing services powered by professional RCM solutions minimize delays, optimize cash flow, and reduce the administrative burden of handling large numbers of claims.
The Role of Medical Billing and Coding in Pediatric Care
Accurate medical billing and coding are essential for pediatric practices to avoid costly errors and ensure that claims are submitted correctly. Pediatric billing services include specialists who are familiar with pediatric-specific codes and procedures, ensuring compliance with insurance requirements. Proper coding of services like vaccinations, developmental screenings, and urgent care visits ensures that the pediatrician is fully reimbursed. Outsourcing medical billing and coding can help pediatricians focus more on patient care and less on the technicalities of insurance claims.
Mediclaim Management and Its Pediatric Billing Services
Mediclaim Management offers expert Pediatric Billing Services tailored to meet the unique needs of pediatric healthcare providers. Their services incorporate the latest in Healthcare IT solutions to streamline the billing process, ensure accurate claim submissions, and manage denials efficiently. With a deep understanding of pediatric-specific coding and RCM services, Mediclaim Management helps pediatric practices improve their revenue cycle while maintaining compliance with industry standards. Their expertise allows practices to enhance operational efficiency and focus on delivering exceptional care to their young patients.
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innonurse · 1 year ago
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Komodo Health introduces a no-code tool for producing analytical insights
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- By InnoNurse Staff -
Komodo Health has launched a new self-service tool for health research teams without coding knowledge.
Read more at Fierce Healthcare
///
Other recent news and insights
A smartphone memory test can detect Alzheimer's disease early on (DZNE)
Redesign Health establishes a startup to change the rules for medication management (Fierce Healthcare)
InStride Health, a pediatric mental health startup, has raised $30 million to expand into new markets (Fierce Healthcare)
Sunwave Health aims to improve behavioral health documentation with MARA, an AI assistant (PRNewswire/Sunwave Health)
Do you want to give up vaping? There’s an app for that (The Conversation)
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foxtrology · 2 months ago
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saturated (1)
dr!joel x resident!reader
inspired by the pitt on hbo | series | ao3 link
notes: this took me way too long to write. but i had to. couldn't stop watching the pitt and thinking about our old man. joel is basically if dr robby and dr abbot had a morally complicated, emotionally constipated lovechild. also abby does not kill joel in this, everyone is friends! god bless america.
warnings: this contains intense and graphic deceptions of medical trauma, emergency room scenarios, death (including children), physical violence, workplace assault, substance use, bodily fluids, mass casualty events, and realistic portrayals of burnout, grief and PTSD in a high stakes-medical environment.
it also includes themes of misogyny, harassment, and implicit threats of sexual violence. reader discretion is strongly advised. please take care while reading--especially if you are sensitive to medical distress, depictions of pediatric injury or real-time crisis response.
word count: 15.k
─────
The morning of the Fourth of July in Austin, Texas, feels like a moment held in the lung, right before the exhale.
That breathless pause before fireworks, before the sirens scream and the ER radios stuttering with trauma codes and stroke alerts and the endless crush of the heat-baked, alcohol-soaked chaos that follows any major American holiday. It’s always the calm before the storm—if you could even call it calm.
You pull into the staff garage at 5:52 a.m. and sit in the car for a moment longer, letting the silence stretch. Black scrubs still freshly laundered, badge clipped, hair pulled back, and your shoes already forming to your feet like muscle memory. You reach for your tumbler, still warm from the coffee Joel handed you in the kitchen an hour ago, already half-drunk.
There’s that brief moment you consider calling out. Just for today. Just to stay in that house, in that bed with him, where he kisses your bare shoulder before telling you to be safe.
But you won’t. You never do.
Because no matter how bad the ER gets—and it always gets bad—this is the only place that makes any kind of sense to you.
Inside, the air conditioning hits like a slap, and you walk past the security station where Bill gives you a small nod, already sipping from his thermos like a man bracing for war.
“Morning, sunshine,” he says. His voice is gravel, his beard immaculate. “You ready for the circus?”
You offer a tired smile. “You know we don't get clowns. We get drunk uncles with bottle rockets.”
He chuckles, shaking his head as he scans another nurse’s badge behind you. “Same difference.”
The ER already smells like overcooked coffee and sterile gauze, and the waiting room—visible through the thick glass partition—looks like an airport at Christmas. People slumped against the wall, some pale, some bleeding, some just desperate for help they’re not sure they need. A woman with a crying toddler in one arm and a vomit bag in the other is standing at the triage desk. Behind her, a man in a tank top clutches his ribs and moans like he’s in labor.
Inside the main ER pod, the low hum of monitors, pagers, and movement never really stops. Maria Miller stands at the hub, perfectly composed, her hands wrapped around a travel mug and a tablet tucked in the crook of her arm. 
“Six a.m. and already short three nurses,” she mutters as you step up beside her. Her eyes flick to you. “Happy Fourth. You look like hell.”
You arch a brow. “Why thank you, Maria.”
She smirks, amused. “I saw your name on the schedule and bumped Henry’s start time earlier. Figured you’d need someone to boss around.”
“Nice. Nothing says holiday spirit like free labor.”
Her mouth twitches into a smile before she heads off toward the trauma bay. You breathe in the scent of antiseptic and coffee. Your shift hasn’t even started, and already you can feel the heat pressing behind your eyes.
“Doc!” Jesse calls out, sliding past with an IV pole in one hand, his badge swinging. “Your favorite guy’s back. Bed three.”
“Which one?”
“Golf cart DUI. Same guy from last month. Says he’s got chest pain.”
You groan, snagging your stethoscope from your pocket and making your way toward the row of curtained bays.
“Hey, doc,” Marlene calls, intercepting you with a chart. “You’ve got a belly pain in seven. NPO since last night, vitals stable, but she’s already mad she’s waited an hour.”
“Great,” you sigh. “Let me guess—says she’s dying?”
“Says she wants to die,” Marlene says dryly. “Progress.”
Inside Bed 3, the familiar face of Mr. Golf Cart is flushed and sweaty, his eyes darting from you to the EKG leads on his chest. He tries to smile through chapped lips. 
“Hey there, doc. Long time no see.”
“It’s been three weeks,” you reply, glancing at the monitor. “You said chest pain?”
“Felt like a raccoon sittin’ on my sternum.”
You don’t bother asking how he knows what that feels like.
“I’ll get your labs and a troponin. Don’t eat or drink anything, and don’t try to leave AMA again.”
“Cross my heart,” he grins.
“You did that last time too.”
Outside the room, Tommy is coming in from the ambulance bay, gloved hands smudged with dried blood, sleeves rolled to the elbow. He spots you and tips his chin up.
“You get the kid with the fireworks burn?”
You didn't fucking get the people who lit up fireworks before the actual holiday.
“Not yet.”
He shrugs. “He’s all yours. Level 2, maybe deeper dermal. Holding it together, though.”
“Great,” you say, and Tommy claps you on the shoulder as he moves past, already shouting something to Frank who’s restocking their rig with trauma dressings.
Frank pauses to shoot you a quick smile. “Morning, doc.”
“You ready for hell?” you ask.
“Born in it,” he replies with a wink, disappearing into the supply closet.
By 6:40, the line to triage has doubled. You slip into Exam 7 where Abby and Mel are squinting at a portable chest X-ray.
“I think it’s a widened mediastinum,” Abby says, uncertain.
Mel frowns. “I think it’s a terrible film.”
You glance between them and sigh. “You’re both right. Let’s get a CT angio. Rule out dissection.”
Abby lets out a breath. Mel nods, jotting it into the chart.
You turn to leave, only to be stopped by Henry in the hallway.
“I finished my charting on the chest pain in four,” he says. “Do you want me to see the laceration in bed nine?”
You nod. “It’s a head lac. Two-centimeter frontal scalp. Walk-in. You can staple it.”
Henry brightens just slightly before hurrying off, excited to staple someone's scalp.
Kathleen stands at the nurse’s station, arms crossed, lips pressed into a line as she watches three nurses hustle to cover six rooms. She barely glances at you, but when she does, her voice is velvet over steel.
“You better love this job, sweetheart. Because it sure as hell doesn’t love us back.”
You offer her a tired grin. “I’m in a toxic relationship with medicine.”
“I’d say get out,” she murmurs, tapping something into the computer, “but I’ve been saying that for twenty years.”
You’re interrupted by Ellie appearing behind you like a caffeinated ghost, her voice quick and panicked. “I just had a guy vomit blood on my shoes and I don’t think that was in the orientation packet.”
You blink. “Was it a large volume?”
“Like a tarantula of blood exploded out of his mouth.”
“Sounds like a GI bleed. Grab Marlene and get him on O2, two large bore IVs, and get a CBC, type and screen, and a bolus of saline.”
Ellie stares at you, eyes wide. “...I love you.”
“You’ll hate me in two hours.”
Dina slides past a moment later, rolling her eyes as she scribbles a note onto a file. “You need me for the kid from the group home?”
“Yeah,” you say. “Bed twelve.”
“I’ll bring stickers,” she mutters, already moving.
You turn a corner to find Riley standing outside a room, fidgeting with her stethoscope.
“I tried to get a BP but the patient wouldn’t stop yelling at me.”
“Welcome to emergency medicine,” you say, opening the curtain.
The hours between 7 and 9 blur into a tangle of trauma activations, overdoses, and one elderly woman who insists she’s seeing angels. Joel appears somewhere around 7:30, silent and gruff, already charting by the trauma desk. His sleeves are rolled up, hair still damp from the shower both of you shared early this morning. He looks at you like he’s already tired for both of you.
You pass behind him and your hand grazes the small of his back, just enough for him to shift his weight and glance at you from the corner of his eye. That’s all. That’s enough.
He doesn’t need to say anything. Nobody talks about it, but everyone knows.
By 9 a.m., you’ve had three traumas, two psych consults, and a toddler with a swallowed battery. A man in a star-spangled bikini was just escorted to the waiting room by Bill, Ellie and Abby giggling in each other's arms watching the scene.
You think you might be sweating through your scrubs.
You duck into the breakroom, finally, and find Tess already in there, sleeves rolled, sipping black coffee and glaring at the microwave like it owes her money.
“Fourth of July,” she says without looking at you. “God bless America.”
You groan and collapse into the chair next to her. “How many stabbings so far?”
“Three. One with a fork. Guy said he was trying to get the last sausage off the grill.”
You snort, leaning back and letting the moment hold. Outside, another ambulance pulls into the bay. The day is only just beginning. And no one’s getting out early.
Just as you sat down, Ellie burst into the break room like her body was still moving faster than her brain could catch up. Her face was flushed with adrenaline, lips parted, hands trembling just enough to tell you this wasn’t a drill.
“Hey—hey—uh—can you—can you come? Right now. It’s that guy in Bay Two. He—he fucking lunged at me.”
Tess straightened up immediately, coffee forgotten. You were already on your feet, coffee sloshing onto the table as you moved past Ellie, her hand catching your elbow.
“I didn’t even touch him. I was just checking his vitals and he went off. Said women shouldn’t be in medicine, shouldn’t ‘touch him,’ called me a goddamn slut, and then he lunged. I didn’t—I mean I moved back—he didn’t land it, but—”
“I’ve got it,” you said, your voice already lowering, the calm hard edge setting in. “You’re okay. You did everything right.”
Tess looked like she wanted to follow, to keep an eye on things, but you shook your head. “Stay here. I got this.”
You headed for Bay Two with a kind of purposeful gait that had nurses flattening themselves against the wall. Marlene caught your eye from the main desk and gave you a look, sharp and knowing. She didn’t need an explanation.
The man in Bay Two was middle-aged, built like someone who spent more time drinking beer than going to the gym, his hands cuffed to the rails, red-faced and sneering. A big, mean, fleshy kind of guy with the kind of grin that made your stomach twist—not in fear, but in a deep, guttural revulsion.
“Here she is,” he crowed when he saw you enter. “Another whore with a stethoscope. They just handing out medical degrees to anyone with a pussy now, huh?”
Your heart didn’t even skip. You had heard worse. But not recently. Not in Joel's ER.
You approached, eyes flicking to the security strap readouts, the monitor, the vitals. Elevated BP, slightly tachycardic, but stable. You stood just out of reach, arms crossed, voice perfectly even.
“Sir, you’re in the emergency department of Austin General. My name is Dr. —”
“Don’t want your fucking name. Don’t want your hands on me either,” he snarled. “Get me a real doctor.”
“That would be me,” you said, unfazed. “You assaulted a medical student. You will now deal with me.”
“You little bitch. You think you got any right to—”
He spat. At you.
The glob landed on your scrub top just left of your collar, thick and glistening.
You didn’t flinch. You refused to give him that.
But when he jerked forward against the cuffs—catching you off guard with a sudden surge of movement—his nail scratched across the base of your neck. Not deep, but enough to burn. Enough to make Marlene, who had followed you at a distance, shout for security.
Enough for Joel, who’d been passing by and caught the tail end of that violent motion, to come to a dead stop at the doorway like a goddamn thundercloud.
“What the fuck did he just do?” Joel’s voice was low, calm. Terrifying.
You blinked, your hand gently coming up to feel the small scratch. Warmth there. Nothing that needed more than a Tegaderm. “It’s fine.”
“It’s not fine.”
You turned to him, quiet, eyes locking. It was one of those moments where a single breath passed and everything unsaid between you stood on the edge of a blade.
“Let me treat him,” Joel said, stepping closer. His voice wasn’t a request.
“Joel.”
He turned to you—deliberate, slow. “You got a goddamn cut on your neck. You’re not treating him. You treat the people who deserve you.”
And then, to your absolute surprise, Joel stepped in.
The patient was smirking again. “Oh, now we got a real man in here,” he said, a mocking grin. “What are you, her boyfriend? Fucking lucky bastard.”
Joel didn’t say a word. He just walked over, gloved up in one fluid motion, and began to examine the man with a detached, surgical coldness that sent chills down your spine.
“What, she send you in ‘cause she can’t handle me? Tch. Figures. You look like the type to put a leash on your bitch, huh?”
Joel wrapped the BP cuff tight—too tight.
“You son of a—”
“Shut the fuck up,” Joel said evenly.
The man froze.
Joel leaned over the bed, voice low and sharp as a scalpel. “You don’t talk to my staff that way. You sure as hell don’t touch anyone. And if you so much as blink wrong again, you’re not gonna like how I handle it. You understand me?”
“You can’t talk to me like—”
Joel pressed the cuff bulb once more. The man hissed in pain.
“I asked if you understood.”
The man’s breath was shallow, face flushing again. “Yeah. Yeah, okay. Jesus. Fine.”
You stood just outside the curtain, your jaw tight, watching Joel work with a professionalism sharpened by fury. You’d seen him rough before—on the job, during trauma—but never like this. Never with his jaw clenched like that. Never with his hands steady as stone but his body bristling with quiet rage.
Kathleen appeared beside you at some point, arms crossed.
“Jesus,” she muttered, watching through the curtain. “What happened?”
“He assaulted Ellie,” you said. “Tried to hit me.”
Kathleen’s eyes flicked to the small scratch at your collar. Her mouth went tight. “Should’ve let Bill loose on him.”
Joel finished dressing the man’s wound with the grace of a wolf playing surgeon. Then he turned, gloves off, and met your gaze. His face was unreadable. But his eyes told you everything.
He was done being polite. For the rest of the shift—and likely the day—he’d be wound tight. He would do his job. But that thin line he normally walked between professionalism and unfiltered rage? It was gone.
You met him halfway in the hall, his hand brushing yours for a second, a brief, nearly invisible contact.
“You okay?” he asked, low, barely audible.
“I’m fine.”
“He hurt you.”
“Barely. Joel—don’t do something that’ll get you written up.”
He exhaled slowly, jaw ticking. “Let ‘em write me up.”
You stared at each other in that fluorescent hallway, footsteps pounding, phones ringing, voices shouting. But all you heard was him.
Behind you, Ellie reappeared, her face tight and pale but determined.
“I’m okay,” she said quietly, more to Joel than you. “He didn’t land it.”
Joel nodded once. “You handled yourself.”
Ellie smiled, just barely. “You going to tell HR about your bedside manner back there?”
He didn’t even look at her. “HR can kiss my ass.”
The ER didn’t slow. The next wave of traumas rolled in before you could even sit. A car crash. A fireworks explosion that nearly cost a teenager his hand. Jesse passed you gauze with one hand and held pressure on a neck wound with the other. Frank and Tommy burst through the ambulance bay doors with another critical, blood on their uniforms, sweat streaking their faces.
The air smelled like burnt flesh and Betadine. The walls were closing in with noise and heat and the never-ending, never fucking ending churn of human pain.
You didn’t stop. You didn’t flinch. Joel didn’t leave your side for more than five minutes at a time. And no one said a word about it. But they all saw. They always did. Even when they pretended they didn’t.
Especially when it came to you and Joel. The glances in the hall, the stillness that took over his body when your name was called out overhead, the way his eyes always found you first, scanning for blood, for bruises, for the smallest fucking thing that might’ve happened in the last ten minutes he hadn’t been watching.
Everyone saw it.
And no one said a goddamn word.
Because Joel Miller didn’t take kindly to anyone prying. And more importantly—he was a better doctor when you were around. They all knew it. It made them like you more. It made them protect you, in a way. Quietly. Stealthily. With a kind of respect that was hard-earned in a place like this.
But respect didn’t stop the world from burning. The ER was a fucking pressure cooker by the time the sun hit its apex. And even though you couldn’t see it from inside—no windows, no light except the harsh fluorescents—the shift in the air was tangible. It was the crescendo. The peak.
The waiting room had filled an hour ago. Now it was bursting. You heard the shouting first. Low and muffled from behind the secured double doors, the ones that kept the main ED from descending into chaos every time someone with a sprained ankle thought they were dying. Then the angry thuds—boots on linoleum, chairs scraping, someone pounding their fist on the glass partition near triage.
You caught the tail end of it from the nurse’s station. Kathleen had her jaw set, arms crossed, standing like a statue of stone as she radioed for Bill. She didn’t flinch as someone outside yelled about waiting four fucking hours with a sick kid. About how the government should burn for the state of the American healthcare system. About how their taxes should be buying better care.
How fucking ironic telling a healthcare worker that.
Jesse muttered under his breath as he wiped his hands on a towel, “People think ERs are fucking drive-thrus now.”
“They’ve always thought that,” Kathleen snapped.
You heard the buzz of the security door unlocking and then saw Bill stride out into the storm, calm as a mountain, broad-shouldered and stone-eyed. The crowd parted enough for him to speak in that deep, measured voice of his. You didn’t hear the words, but the tone was clear—this isn’t a negotiation.
Someone pushed. Big mistake.
Bill moved faster than anyone expected, crowding the man backward with one hand braced on his chest, steering him toward the wall. “Don’t. Touch. My. Staff,” you heard him growl.
The man’s arms lifted—weak, blustering, drunk or angry or both—but Bill wasn’t even winded. He radioed for APD, kept himself between the chaos and the front desk, and when the doors buzzed shut again ten seconds later, the noise behind them didn’t stop—but it dulled.
“Fourth of fucking July,” Marlene muttered as she walked by. “Every goddamn year.”
The real storm, though—the one that mattered—was what came through the ambulance bay.
The first call came at 10:41. Child. Near-drowning. Backyard pool. No adult supervision. ETA: two minutes.
Then another. And another. And another.
You stood in Trauma One as Maria directed the incoming flow like a symphony conductor, her tablet clenched in her hand like a sword. “Put the six-year-old in Trauma Two. Get Pediatrics paged down here. Respiratory on standby. Tell CT we need head and C-spine for all drownings, intubate as needed.”
“Where the fuck are we supposed to put them?” Jesse asked, not even trying to hide his frustration. “We’re at max capacity!”
Maria’s voice sliced through the noise. “Make room. Stack if you have to. Double rooms. Trauma hall overflow. I don’t give a shit. We are not turning away pediatric codes.”
And you were moving before you even processed it. Pulling on gloves, snapping goggles over your eyes, shoving trauma shears into your pocket.
The first kid—boy, seven or eight—was cyanotic, limp, his chest rising only slightly under bag ventilation. Joel took point, barking orders with brutal precision.
“1 mg epinephrine IV push. Get ready to tube. Peds crash cart now. We need a line—Jesse, get that line. You, get that IO if you have to.”
“Got it.”
“Push faster.”
The parents were in the hallway screaming. You didn’t stop. There was no room for that. You could fall apart later.
The second kid—blonde, five, blue lips, vomit around her mouth—was rushed into your room. You caught her from the gurney mid-transfer, nearly dropping to your knees with the dead weight.
“Started CPR on scene,” Tommy said breathlessly. “No pulse for four minutes. They pulled her from the shallow end.”
You moved on instinct. “Start compressions. Get the crash cart. I need 0.01 mg/kg epi. Let’s go.”
You worked until your arms felt like jelly. Until sweat was dripping down your spine, soaking through your black scrubs. Until your fingers ached from bagging, from checking pulses, from writing code notes that your brain refused to absorb. You snapped orders, half-yelled at Abby for hesitating too long on a tube size, and didn’t even feel guilty.
These were kids. And they were dying.
By the time you got the third one—a boy, barely three—he was already cold. Tommy handed you the chart with blood on his cheek, his eyes hollow.
“Nothing in the field,” he said.
You stared at the kid. You didn’t say anything. You intubated anyway. You tried.
Joel came in halfway through and didn’t even look at the clock. He just picked up the ambu bag, his face carved from stone.
“Come on, baby boy,” he murmured, almost too quiet to hear. “Come on. Breathe.”
The rhythm of the bagging. The flatline. The futile compressions.
You heard Mel whisper, “He’s gone.”
But you kept going. Just long enough. Just to make sure.
When you finally called it—when the silence came—you felt it ripple through the room like a knife through skin.
Joel didn’t move. He looked down at the boy for a long time. Then up at you. His jaw clenched.
You looked away. You left the room. And still, the day didn’t stop.
Another crash. Fireworks embedded in a thigh. A man who’d tried to jump a fence with sparklers in both hands and shattered his femur on landing. Someone else with a roman candle burn across their cheek and no fucking idea how they got it.
Again. It was daylight. Why the fuck are people doing fireworks already.
You caught a glimpse of Ellie across the trauma hallway, covered in soot, helping Riley wrap a dressing. Her hands were steady. Her mouth was set.
Marlene passed you a water and said, “You need to drink something or you’re going to pass out.”
You didn’t even realize your hands were shaking.
By the time you made it back to Joel, he was standing at the med station with his palms flat on the counter, shoulders hunched, breathing slow and heavy like a man trying not to crack his ribs from the inside out.
You stood behind him. Quiet. Present.
“He was so young,” you said, voice hoarse.
He nodded once. “I know.”
“We did everything.”
“I know.”
You didn’t touch him. You couldn’t. Not here. But his hand brushed yours when you reached for the pen, just the smallest press of his pinky against your skin. It was enough.
You stayed like that for a breath. Then two. Then the radio crackled again. Another code. Another ambulance. No rest. Not today. And not now.
It was barely past eleven and the ER had transformed from a battlefield into something more biblical. Plagues of chaos. Floods of noise. Screams from the trauma bays, sobbing from the waiting room, blood on the linoleum, and no time to wipe it up before someone else was bleeding over it.
You were halfway through stitching up a forehead lac—nine-year-old girl, tripped chasing her older brother with a sparkler—when your pager buzzed again. Rapid succession. Three back-to-back calls.
You looked down at the kid, her tiny legs swinging off the gurney, lips trembling.
“You’re doing amazing,” you told her. “Almost done, sweetheart. Just five more.”
She gave a brave nod, but her chin wobbled anyway. Jesse handed you the next suture without speaking, the tension behind his eyes saying more than words ever could.
The second the stitches were in, you stripped your gloves and tossed them toward the bin, already moving. The noise hit you in waves as you emerged back into the hallway. Another stretcher wheeled past, pushed by Tommy and Frank, both breathless.
“Sparkler injury!” Frank shouted. “We’ve got a foreign object in the left orbit. Firework’s still in the goddamn eye!”
You blinked. “Still in?”
“It’s lodged. Like a fucking spear.”
They wheeled the teen—maybe fifteen, maybe sixteen—into Trauma Four. Blood was pouring from the socket, and he was screaming loud enough to rattle your skull. The jagged metal tip of a bent, burnt-out sparkler jutted from the flesh where his eye should’ve been. His hands were tied down. One eye wide with terror.
“Why the fuck are people lighting fireworks before the sun even sets?” you muttered, pulling on a fresh gown.
“Because Americans are stupid,” Marlene said flatly, handing you saline flushes.
It was chaos in the room. Abby tried to push meds, but the kid kept thrashing.
“Stop, stop, stop,” Abby shouted. “I can’t get the vein!”
“Hold him down,” you snapped. “Get a sedative on board. Joel!”
He was already beside you, steady hands gripping the boy’s shoulders, voice firm and low, “You gotta stay still, kid. We’re gonna fix you up. Just hold still.”
“But my eye! My fucking eye—!”
“We see it,” you said. “You’re not gonna lose more if you let us help. We’ve got you.”
Blood ran down your gloves. The sparkler was still hot when Tommy pulled it from the wound—safely, slowly, with Joel guiding the angle—and the kid passed out from the pain.
You stepped back, adrenaline crashing into your bloodstream. No time to breathe. No time to break. The second you stepped out of Trauma Four, Ellie sprinted up, pale and winded.
“There’s a kid in triage with full-body hives,” she gasped. “Face is like—bad.They think it’s an allergic reaction. Face paint.”
You blinked. “Fucking face paint?”
“Red, white, and blue stripes,” she said, still panting. “Apparently it was ‘organic.’ Mom said he’s never had allergies before.”
“Where is he?”
“Exam 6. Jesse’s already pushing Benadryl but he’s wheezing. He’s scared.Like full-on panicking.”
You followed her down the hall, cutting through noise and stretchers and the rising scent of blood and chlorine and burning hair. The kid was around six, covered in angry red welts, his face ballooning, lips beginning to swell.
His mom was sobbing.
“I didn’t know—oh God, I didn’t know—I thought it was just paint, it was from Whole Foods, it said natural—”
“It’s okay,” you said quickly, crouching down. “Hey buddy, can you take a deep breath for me?”
He tried. It wheezed out in a thin rasp.
“Epi,” you said. “Right now. Auto-injector to the thigh. Push fluids. O2.”
Ellie already had the mask on him. Jesse handed you the pen.You jammed the injector into his leg through his shorts. He jolted, eyes wide, and then started to cry. That was a goodsign.
“Good job,” you said, breathless. “You’re gonna be okay, kid. Just keep breathing for me, alright?”
A nurse from Peds rolled in with an Epi drip and you handed off. Your hands were shaking again. You didn’t even realize it until Jesse brushed his fingers against yours.
“You alright?”
You looked down at your scrubs. More blood. More paint. More fucking sweat.
You nodded. “Yeah.”
You were lying. Your stomach hadn’t stopped twisting since the last code. But you kept going. Because that’s what everyone here did.
You barely made it two steps out of the room before Henry came barreling up the hallway.
“Doctor!” he wheezed. “We’ve got a—uh—a patient from a hot dog eating contest! They—they passed out mid-competition. Obstructed airway, I think. They’re coding in Bay Eight.”
You ran. By the time you got there, Riley and Mel were already doing compressions. A man—mid-thirties, athletic build—was purple-faced and frothing at the mouth. His stomach was distended and there was a faint smear of ketchup across his cheek.
“Hot dog still in there?” you asked, snapping gloves on.
Riley nodded. “We tried Heimlich. Failed. We’re suctioning but it’s not clearing.”
You stepped up. “Forceps. Laryngoscope. Bag valve.”
You shoved the scope into his mouth, peered past the pink folds of tissue. There it was—a slick, greasy chunk of frankfurter lodged in the airway like a cork.
Joel appeared behind you.
“You good?” he asked.
“Hand me the damn forceps.”
He did. You fished for it—deep, too deep—and pulled it free with a sickening squelch. The hot dog thunked to the floor like something cursed. Mel jumped in with the ambu bag.
“Pulse is back,” she confirmed a moment later. “It’s weak. But it’s back.”
“Never,” Riley panted, sweat plastering her baby hairs to her face, “never fucking entering a hot dog contest. Ever.”
You were leaning against the wall now, chest heaving, and your neck throbbed where that earlier patient had scratched you. You’d forgotten about it. The pain was back now, a dull ache that pulsed with your racing heart.
Joel stood in front of you, brow furrowed. “You’re not okay.”
You looked up. “Neither are you.”
“I know,” he said. “But I’m not the one bleeding.”
You glanced down. The scratch had reopened, blood soaking the collar of your scrub top. Not much. Not dangerous. Just another wound in a long, long list.
You swallowed hard. “Just a scratch.”
Joel didn’t say anything. He didn’t have to. He just stood beside you as the chaos surged around you again.
Because there was no end to it. The doors would keep opening. The stretchers would keep rolling. And you’d keep going. Because no one else could.
That was the brutal, blistering truth of it.
You stood there—goggles tight on your face, blood crusted on your collar, gloves pulled on with a snap and your spine locked straight—not because you had some noble sense of duty or unshakable resolve, but because you couldn’t afford to stop. Because every time you even thought about sitting down, someone coded. Someone crashed. A kid stopped breathing. A man lost an eye. A woman sobbed over her infant’s tiny hand as the nurses tried to get a line in, whispering, “please, please, please” like a rosary.
And now, apparently, someone had blown themselves up in a fucking Porta-Potty.
"Incoming," Tommy said grimly, as the double doors from the bay burst open.
“Trauma One!” Maria barked from across the hub. “Now!”
Frank came in with the gurney, face tight, jaw locked. The smell hit first—burned fabric, scorched hair, shit. Literal human waste, clinging to the burned man’s clothes, his skin. His legs were torn up—open wounds studded with plastic and fragments of shattered porcelain from the toilet itself. One hand was charred black. His skin was red and sloughing, patches of it bubbling.
"Jesus Christ," Jesse muttered, yanking a mask up over his nose.
"Firework in a Porta-John," Tommy said as he wheeled the guy in. "M-80. Don’t ask me how."
"Someone fucking would on the Fourth," you muttered, snapping on another gown. “Where was it placed?”
“In the bowl,” Frank said. “He sat on it.”
“Of course he did.”
Joel was already across from you, snapping on a pair of surgical gloves with a sound that could slice through bone. His jaw was clenched, face unreadable.
"Vitals are trash," Mel said, sliding in with a monitor. "BP’s in the tank. O2 sat’s crashing. We need to intubate now."
You grabbed the laryngoscope while Joel prepped the tube. He was calm—dead calm—the kind of calm that comes before an explosion. His voice cut through the room with that hard, sharp edge.
“Lidocaine in. Cricoid pressure. Bag him.”
Jesse handed you the blade. You guided it into place, careful and precise. The airway was distorted but patent. Joel took over. The tube slid in on the first pass. Of course it did.
You looked down at the man’s legs, charred and littered with embedded shrapnel and what looked like wet confetti.
“Someone tell me that’s not toilet paper in his femoral wound.”
“Oh, it is,” Joel growled.
Marlene gagged.
“Flush the wounds. High-dose antibiotics. He’s septic already, or he’s about to be.”
You cleaned what you could while Kathleen handed you a syringe. “Chemical rash on his back. He landed in the tank.”
“Tank was full,” Tommy added helpfully, stepping out of the way.
“Jesus,” you muttered.
“He’s not gonna make it through the hour,” Joel said, bluntly. “Let’s get plastics and trauma surgery down here. He needs a burn unit bed but I’m betting San Antonio’s full.”
You didn’t ask how he knew that. You just nodded.
“Let’s call it in anyway.”
There wasn’t a single clear patch of this man’s skin left untouched. He looked like the Fourth of July had tried to swallow him whole and shit him back out.
You worked fast, coordinating with a speed that could only be honed by months—years—in this warzone of a hospital. Joel didn’t look at you once, not directly, but he moved around you like gravity, always one step ahead, always covering your blind side. He handled the patient with a kind of ruthless efficiency that others might’ve called cold.
You knew better. Joel wasn’t cold. Joel was focused. He didn’t waste softness on the people who didn’t deserve it. That man on the table? He might have deserved pity. He sure as fuck wasn’t getting it.
Joel tore his gloves off once the patient was stabilized enough for surgery and tossed them in the bin like they’d personally offended him. His hands shook once—barely noticeable—before he shoved them into his pockets.
“Fucking idiot,” he muttered.
You didn’t disagree.
And you didn’t stop moving.
Because the very next second, Ellie poked her head in.
“Uh, we’ve got a kid in Exam 3? Swallowed a toothpick? Like…a flag one. From a cupcake.”
You blinked. “A flag?”
“Yeah, like the American flag. From the dollar store. She’s five.”
“Is she choking?”
“No, but the family’s…a lot.”
“How a lot?”
“You’ll see.”
You left Joel in Trauma One and headed toward Exam 3. You could hear them before you opened the door.
The mother was sobbing. Loudly. Hiccuping breaths and wailing cries like she was auditioning for a soap opera. The father was yelling—at the kid, at the mother, at the air. Clearly drunk already, beer-breath sharp in the room.
“She’s gonna die,” the mom wailed. “My baby’s gonna die from a cupcake!”
“She ain’t fuckin’ dyin’,” the dad snapped, swaying slightly. “Y’all makin’ a big deal about nothin’!”
“Why did you even let her have the cupcake? You always do this—you don’t watch her!”
“She’s five, she can eat a goddamn cupcake! We all did when we were kids!”
“She swallowed a fucking flag, Kyle!”
In the corner, Grandma was sitting in a plastic chair, swaying gently and singing America the Beautiful off-key and with unnerving enthusiasm.
“O beautiful… for spacious skies…”
The child—the only reasonable person in the room—sat on the bed kicking her heels, totally unbothered.
“I feel fine,” she said. “Can I have another cupcake?”
Dina was already in the room, crouched next to the mother, talking in that soft, steady voice she used when everything was teetering on collapse.
“She’s okay,” Dina said. “She’s alert, she’s talking, she’s not choking. Let’s just take a breath, alright?”
The mom sobbed harder. You stepped in, hands in the air like you were entering a hostage negotiation.
“Hi, I’m one of the doctors. I hear we had a little cupcake situation.”
“She swallowed a flag,” the dad said proudly. “America!”
“She’s fine,” the mom cried. “But what if she’s not? What if it cuts her up on the inside?”
“Ma’am,” you said gently, approaching the little girl. “What’s your name, sweetheart?”
“Kaylee.”
“Hi, Kaylee. Can I press on your tummy a little?”
She nodded solemnly. “You’re pretty.”
You smiled. “So are you.”
You examined her—no abdominal tenderness, no signs of perforation, vitals stable. You made a note to get an abdominal X-ray, just to make sure the damn flag wasn’t sharp enough to do damage. But this wasn’t a code. This was a circus.
Dina stood up slowly, easing the mom back onto the chair.
“She’s gonna be fine,” she said firmly. “We’re gonna monitor her and make sure everything passes okay. But you need to breathe.”
The grandma took that moment to hit a high note.
“...for purple mountain majesty…”
You looked at Dina. Dina looked at you.
“I’ll give them some water,” she muttered. “And maybe a Valium.”
You squeezed her arm gently. “You’re a national treasure.”
Dina smirked. “Someone has to be.”
You stepped out of the room and leaned your head against the cool wall for just a moment. Just a moment of silence. Of stillness. But there was no such thing today.
There were voices shouting again. Footsteps pounding. Another trauma called overhead. And Joel’s voice, snapping sharp in the distance—
“Get me a fucking gurney now or I’ll throw this guy over my shoulder myself!”
You straightened your spine. Wiped your hands. And ran toward it.
You didn’t know what room it was yet. You didn’t know who was bleeding, coding, or screaming—but the air in the ER had changed again, like it had decided to climb one more goddamn rung on the ladder to hell.
By now it had bled into noon, and that meant it wasn’t just a peak anymore. This was the full boil. No more build-up. No more lulls. Just the ER at its most unhinged, bloated with bodies and chaos and pain, stinking of chlorine and antiseptic and sunburned skin.
You rounded the corner, expecting another trauma code, expecting the worst—and instead, you got two teenage boys, one on a wheelchair, the other pushing him with the nonchalant energy of a kid who thought his own mortality was at least a decade away.
“We tried to do a Slip ’n Slide,” said the one in the chair, grinning despite the fact that his wrist was visibly fractured and his shoulder was dislocated at an angle that made Jesse wince. “It was sick.”
“We used trash bags and Dawn,” his friend said, absolutely proud of the decision. “It’s, like, eco-friendly, right?”
“Yeah,” the injured one added. “Until he slipped and hit the sprinkler head buried in the lawn. I thought his bone came out of his arm, but it was just soap and panic.”
“Yo, are you my doctor?” the boy said, eyes dropping to your badge, then slowly crawling back up to your eyes. “Because like…you’re so hot.”
You blinked. Behind you, Jesse choked on his laugh.
“Yeah,” the boy continued, winking despite his very obvious pain. “I think I just dislocated my heart.”
“Okay,” you said, stepping in. “We’re going to get your vitals, your arm back in its socket, and absolutely never talk like that to a medical professional again.”
“But if I die—”
“You won’t.”
“—will you come to my funeral?”
“I’ll resuscitate you just to kill you again.”
Jesse wheeled the kid into Exam 5, cackling.
“I love this job sometimes,” he muttered. “Teens flirting with trauma. Classic.”
You didn’t get far before Joel appeared. He didn’t say anything. Didn’t have to.
Just looked at the kid, then looked at you, and that single blink—slow and pointed—said all of it.
Joel was not the jealous type.
Joel was the territorial type. Like a wolf. Like a loaded weapon just waiting to be cocked.
“Relax,” you muttered under your breath as you passed him, shoulder brushing his. “He’s seventeen and concussed.”
Joel growled low in his throat. Actually growled. “Little bastard keeps looking at your ass, he’ll leave here with more than a cast.”
You fought back a smirk. “He’s barely out of diapers.”
Joel shot you a look like that wasn’t the goddamn point.
But then Tess was suddenly at your side, moving at speed, hair half-falling from her bun, eyes wild and voice sharp.
“Hey—Miller. You. Room 12. Right now. I don’t have time for this.”
“What is it?” you asked, already falling into step beside her.
She didn’t break stride. “Geriatric. Took too much THC lemonade. She thinks she’s ascending. I need backup before she climbs the fucking bed rails.”
You and Joel both followed.
Inside Room 12 was an elderly woman in a red-white-and-blue shawl, lying in a hospital gown with her arms stretched out like she was ready to be crucified.
“I hear the trumpets,” she whispered, eyes glassy. “They’re calling me home.”
Ellie stood nearby holding an EKG lead in one hand and what looked like an empty bottle of artisanal lemonade in the other. “Her granddaughter brought this,” she said. “She thought it was regular lemonade.”
“I thought it was an Arnold Palmer,” the woman corrected, voice dreamy. “It tasted like freedom.”
“She chugged half the bottle in the sun,” Tess explained. “Heart rate’s 140 and rising.”
Joel moved to the monitor, eyes flicking over the numbers. “BP’s shit too. You got a line?”
“Yeah,” said Mel, double-checking the drip. “But she keeps pulling at it.”
“Ma’am,” you said gently, approaching the bedside. “You’re not dying. You just had too much cannabis.”
Her eyes found Joel. They widened. “Saint Peter?”
Joel stared. “No.”
“Have you come to escort me?” she whispered, reaching out a hand.
Joel took a single step back. 
“I’m ready,” she continued, eyes glistening. “Take me into the light.”
“She needs Ativan,” Abby said, handing it off. “And maybe like…a priest.”
“Just keep her in the bed,” Tess said. “She keeps trying to crawl toward the halogen light in the ceiling.”
Joel turned away, muttering, “I fucking hate this holiday.”
You looked at him, lifting a brow. “You hate every holiday.”
“Yeah,” he said. “And this one’s the worst.”
It would’ve been funny, if the ER hadn’t chosen that exact moment to go off the rails again.
Marlene poked her head in. “You guys got a throat bleeder in Exam 2. Woman swallowed a metal bristle from a grill brush. Says she noticed halfway through her hot dog but didn’t wanna be rude.”
“What the fuck,” you muttered.
“She’s stable,” Marlene added. “But her sister’s already yelling.”
You and Joel exchanged a look. Of course.
You followed Marlene down the hall, Ellie falling in behind you with Riley trailing behind her, both clutching their tablets and trying to finish charting from the last five traumas. Henry passed you in the other direction, visibly sweating, muttering something about a broken ankle in the hallway again.
Inside Exam 2, the patient sat clutching her throat, blood on her napkin. Next to her stood a woman in her fifties with perfectly curled hair, a clipboard, and the righteous fury of a suburban mom who read one article once.
“She swallowed what?” Joel asked, arms folded.
“A grill bristle,” you said, eyeing the bleeding. “Probably from one of those wire brushes. They snap off sometimes. I read about this.”
The sister stepped in front of the bed like a lawyer at a press conference.
“This is why I tell everyone not to use metal tools when cooking. There are non-toxic options. Bamboo. Silicone. But nobody listens to me. And now this happens!”
“Ma’am,” Joel said flatly. “I don’t give a shit about your non toxic options right now. Your sister is bleeding.”
“Excuse me?”
“You’re excused,” he said, walking past her to check the monitor. “Let the doctors work.”
You fought a smile and grabbed gloves. The woman on the bed gave you a tired, slightly woozy grin.
“I mean, it was a good hot dog,” she rasped. “Didn’t wanna ruin the vibe.”
“Next time,” you said, gently tilting her head, “ruin the vibe.”
She chuckled. Then winced.
Dina appeared at the doorway, her voice a breathless sigh. “There’s a baby on the floor in the waiting room trying to eat a Pop-It firework. No parents in sight.”
“I’m gonna commit a felony,” Joel muttered.
“I’ll hold your pager,” you said.
Everyone laughed. For half a second, it felt like the room wasn’t collapsing. Then the lights flickered. The power hiccupped. And another trauma was called over the PA.
You looked at Joel. He was already moving. And you followed him. Because no one else could.
That sentence followed you like a goddamn shadow.
It echoed in your head as you and Joel passed through the final security doors into the waiting room—a wall of sweaty, shouting, sunburned humanity. It was packed to the gills. Coughing kids, cranky geriatrics, one guy snoring against the vending machine, another pacing the floor in flip-flops and nothing else but an American flag wrapped around his waist like a towel.
The Fourth of July in Texas. The absolute worst kind of magic.
And right in the middle of all of it—by the edge of the grimy tiled floor, next to an overflowing trash can—was a baby. A real-ass baby.
Maybe nine months old. Crawling across the fucking floor with a soggy diaper and an open Pop-It firework gripped in his drool-slick hand like it was a holy relic.
“God damn it,” Joel muttered, and you were already moving.
You scooped the baby up before he could slam the firework into the floor. He shrieked in protest, flailed in your arms, and then—somehow—managed to sneeze directly into your mouth.
You froze.
“Did he just—?”
“He fucking did,” Joel confirmed.
Your jaw clenched.
Joel took the firework from the kid’s hand and hurled it into the nearest trash bin like it had personally offended him. Then he looked around the room with all the tenderness of a hunting dog tracking a wounded deer.
“Whose kid is this?!” he bellowed.
Silence. No one moved. No one looked up.
“I said—whose fucking kid?!”
You rocked the baby gently on your hip. “He doesn’t have a wristband. He’s not registered.”
Joel scanned the crowd, eyes narrowing. “We’re calling CPS.”
“I’ll call 'em,” Dina said, appearing from nowhere, eyes exhausted and jaw tight. “Jesus fucking Christ. This is the third abandoned kid today. Do people think this is a goddamn daycare?”
“Apparently,” Joel growled.
The baby cooed in your arms and drooled on your scrub top.
You sighed. “Okay. This one’s mine now. I’ll call him July.”
Joel looked at the baby. The baby blinked at him, completely unbothered.
Joel didn’t smile. But you could tell he wanted to. He just touched the baby's foot making him giggle.
Then the screaming started. Not from the baby. From the ambulance bay.
You both turned just in time to see Tommy and Frank wheel in a gurney that looked…wrong. The patient wasn’t lying flat. She was…angled? Propped up in some kind of twisted plastic hellscape. And she was howling.
“I’m stuck!” she screeched. “I cannot feel my ass!”
“She got melted into the chair,” Frank explained as they wheeled her past the desk. “Aluminum frame, plastic seat. Left it out in the sun too long. She sat down and… boom. Cheeks fused.”
“She tried to stand up and the chair came with her,” Tommy added, still holding the IV bag. “Had to cut the lawn hose to fit her through the door.”
You blinked. Marlene blinked. Joel’s eye twitched.
“Get her into Procedure Three,” Maria barked from behind the main hub. “And prep a burn tray. This is gonna be a surgical extraction.”
You followed the gurney in, July passed off to Dina, as Joel grabbed the trauma shears. Dina disappeared down the hall to hand the baby off to Social Work. Jesse, Tess, and Riley were already in the room. Henry stood against the wall, pale as a sheet, staring at the patient like she was some rare museum exhibit.
“Don’t just stand there,” Joel snapped at him. “You’ve seen an ass before.”
“Not like this,” Henry whispered.
The patient was red in the face, gripping the sides of the chair like it was a ride at an amusement park. 
“She’s got second-degree burns on the posterior,” Mel said, pulling on gloves. “We’re gonna have to cut the chair off in sections.”
“She’s got third-degree pride damage,” Abby muttered.
“I heard that!” the woman yelled.
“We’ll get you out, ma’am,” Tess said, rolling up her sleeves. “But you need to hold still. If you twist, you’ll rip skin.”
“I’ve been twisted since brunch,” the woman moaned. “Do it fast!”
You stepped in with trauma scissors and started cutting the straps of her sundress where it had fused to the chair legs. Joel knelt at the base, prying at melted plastic.
“Jesse, saline. And get me lidocaine. Abby—scalpel. Riley—monitor. Now.”
They moved. You moved. The chair creaked as Joel wedged the blunt scissors into the side and began to snip.
“You’re gonna feel pressure,” you warned.
“I feel humiliation!” the woman shouted.
The room was chaos. Screams. Grunts. Sweat. Abby nearly slipped in a puddle of saline. Jesse started humming The Star Spangled Banner under his breath like it was going to save his soul.
“Pressure coming,” Joel warned.
“Now,” you said. “Mel—on the back panel.”
One final snap—and the chair split. The woman yelped. Joel caught her before she could slide off the gurney. Burns covered the backs of her thighs and ass. Angry red welts. Plastic still clinging to the skin.
“Get burn cream,” Joel barked. “And wrap it. We’ll get plastics to consult. If this gets infected—”
“It won’t,” you said quickly. “We won’t let it.”
The woman sniffled. “Do I… still have an ass?”
You nodded solemnly. “It’s just less optimistic now.”
Joel gave you a look. But it was almost—almost—amused.
Jesse gently covered her with a sheet. “You’ll be fine, ma’am. But maybe next time, check the chair temperature before you park it.”
“Fuck you,” she said.
“You’re welcome.”
Tess wiped her forehead. “Somebody better bring me a margarita after this.”
“I got a jug of hospital juice,” Riley offered.
“Go to hell.”
Ellie leaned in through the curtain, tablet clutched in one hand. “Someone just walked in with a buncha sparklers taped to their chest.”
You stared. She stared. You sighed. Then reached for your stethoscope.
You didn’t even get the damn thing around your neck before it happened. The world cracked in half.
A boom, deep and cavernous, roared through the hospital like a goddamn earthquake. The lights flickered. The floor shook. Somewhere far off, car alarms screamed to life. You had just turned to Joel, mouth open to ask what the fuck was that, when the second explosion hit.
It was louder. Closer.
You staggered, caught the edge of the stretcher to steady yourself. From down the hall came the sound of shattering glass. An IV pole tipped, clattered to the floor. Somewhere, someone screamed. The lights dimmed, buzzed, then held steady, flickering like they were considering going out entirely.
Joel was already moving. You didn’t even see him react—just felt it. A hand on your arm. Hard. Gripping. Yanking you in, fast.
He pulled you to him, one arm curling instinctively around your back, his chest flush to yours as the wall behind you both trembled under the blast’s echo.
You could feel his heart racing through his scrubs. His breath was sharp, tight, furious.
“Are you hurt?” His voice was low and sharp, a breath away from a growl.
“No,” you panted. “I’m—what the fuck just happened?”
Across the ER, controlled chaos exploded.
Maria’s voice bellowed from the central hub, clear and commanding, her voice slicing through the panic. “Mass casualty protocol! All trauma bays cleared now. Abby, Mel, start staging the clean beds! Riley, Henry, grab gurneys and start lining the main hallway. Jesse, Marlene, alert radiology and prep the portable X-ray machines—now!”
Joel looked out the window. Smoke. Billowing, black smoke rising from the supermarket lot across the street. People running. Screaming.
“Oh, fuck me,” Kathleen said from the nurse’s desk, eyes wide. “It’s the firework truck.”
“The illegal one,” Marlene added, her voice flat with horror. “That vendor with the fucking tent full of black market shit—it’s gone.”
“Exploded,” said Ellie, appearing at your side, breathless and pale. “It just—exploded. Twice. We felt it inside.”
You looked toward the windows. The supermarket parking lot was chaos. Fireworks still going off mid-air—rockets bursting into reds and greens like it was New Year’s instead of noon. People were running toward the hospital, some limping, some screaming.
A kid was carried by a man soaked in blood.
A woman fell into the bushes near the entrance.
The hospital doors hadn’t even fully opened before Bill was there, already barking into his radio, hand on his hip, stance like a fucking soldier. “We’ve got multiple casualties inbound. Lock this place down, route ‘em to emergency access. Tell APD we need crowd control now. No civilians inside the ER.”
“Tell Fire they’re still igniting,” Tommy shouted as he hauled a backboard off a gurney. “Shit’s not out yet. We’re gonna have more.”
Maria turned to you and Joel. “You two. Trauma Three. First waves’ll be here in thirty seconds.”
The doors burst open again. Sirens now. So many sirens.
Then they came.
The first patient—dragged in by two strangers, clothes still smoking—was screaming, half his face red and blistering, the skin peeling off his arm like plastic wrap. “It was in my goddamn truck!” he yelled. “I told him not to park it next to the propane—”
“Vitals tanking,” Mel called, rushing up with the monitor. “BP 84 over 40!”
“Get fluids. We’re intubating now,” Joel barked. “You—” he pointed at Henry, who flinched— “cut that shirt off and watch for chest expansion.”
“I’ve got an O2 mask!” Ellie shouted, barreling in behind him.
Abby was already trying to start a line, fumbling.
“Abby—center that angle or you’re gonna blow it,” Joel snapped. “Get out of the way. I’ll do it.”
You slipped in with the burn kit, pushing the cart to the side of the bed. “We need lidocaine, silvadene, morphine. He’s gonna crash.”
Second patient came in a minute later.
Woman. Late twenties. Not screaming.
Because she couldn’t breathe.
A rocket had shot straight through the windshield of her car. Glass shredded her chest. One rib cracked. The pressure had collapsed her lung.
“She’s hypoxic,” Jesse called, wheeling her into Trauma Two. “Sat’s in the fifties. Trachea’s shifting. We’ve got a tension pneumo.”
“I’m needling her now!” you said, already gloved up.
Joel moved to your side without hesitation.
“Three fingers below the clavicle. Do it fast or she’s gone,” he said, voice calm, commanding. Like the world wasn’t on fire.
You pierced the chest wall with the needle, felt the rush of air, watched her chest rise.
“She’s stabilizing,” Riley said, breath catching.
Another one.
A child.
Carried in by a stranger, his leg soaked in blood, a metal shard sticking out just above the knee. Screaming. Wailing.
“Shrapnel,” Marlene said. “Straight from the explosion.”
Dina rushed in behind them, voice shaking. “Mom’s not with him. Said she ran off looking for his little brother—he’s alone.”
You pushed the adult crash cart aside, swapping in peds trauma.
“Stay with me, kiddo,” you whispered, eyes locking with his. “You’re not alone anymore.”
Joel appeared beside you, hands already working to stabilize the limb. “Get that pressure dressing on. Marlene—lidocaine local. I’m not cutting metal until he’s numb.”
“Roger that.”
“We can’t pull it here,” you said. “Not without imaging. We don’t know what it’s resting against.”
Joel’s jaw clenched. “Then we work around it. Until radiology’s ready.”
The ER was vibrating with sound. The doors slammed open again, and Frank came in pushing another gurney.
“Burns and lacerations,” he said. “Lost a shoe, still has a firework tube in his hand.”
“Oh for fuck’s sake,” Tess muttered, meeting him at the door with a splint and gauze. “Get me a tray. And a scalpel. I think we’re cutting around this one.”
“Where’s Ortho?” Maria asked, hands on her hips. “Someone page Ortho, I want consults in fifteen minutes or I’m dragging them down here myself!”
“Dr. Gail is in surgery!” Riley shouted back. “I’ll grab second call!”
Kathleen blew past the hub with four gurneys trailing behind her like a train, three med techs jogging to keep up. Her face was stone.
“Ten more ambulances on the way,” she called. “The parking lot’s a war zone.They’re staging by triage. We need everyone outside of Trauma Hall to prep overflow.”
You grabbed a portable monitor and a trauma checklist, snapped at Henry to follow.
He hesitated.
Joel barked—“Go.”
Henry went.
You didn’t see where Joel ended up for the next ten minutes. You were too busy. You were stitching, packing wounds, answering rapid-fire questions from Ellie, who was practically vibrating from adrenaline. You passed Jesse in the hallway, sweat pouring down his face, three soaked gowns already in the trash. You heard Abby shouting for a bolus in Room Seven, saw Mel carrying a tray of wrapped scalpels like her life depended on it.
And then—
Joel was beside you again.
You didn’t know how long it had been.
His eyes scanned you fast, checking every inch of you in a breathless beat.
“You okay?”
You nodded.
“You?”
He didn’t answer.
But his fingers brushed your hand for just a second. Just long enough to say still here.
And then more patients poured in.
And you both ran toward it.
There wasn’t even time to think about how long it had been since you’d eaten, or went to the bathroom, or even blinked without your eyeballs stinging. The air in the ER had thickened—hot, metallic, sour with sweat and sterilized burn dressings. Every inch of your black scrubs was soaked in blood, saline, and god knew what else. You couldn’t tell where your pulse stopped and the noise around you began.
There was no clock anymore. Just waves of patients. Gurneys rolling in, IV poles clattering against corners, bloody towels slapping the linoleum. You moved through it like muscle memory—stitching, bagging, ordering scans, barking instructions to interns who hadn’t even hit their first bowel movement on the job.
Joel was a few paces ahead, pulling a C-collar from a wall mount, jaw tight as iron, barking over his shoulder to Riley, who was jogging to keep up with a trauma sheet.
“Have the trauma room ready before I get there, or I’m working on this guy on the floor. Got it?”
“Got it, Dr. Miller,” she said breathlessly, already sprinting down the hall.
You saw Henry leaning into a hallway crash cart, face pale and shiny. He’d just finished assisting with a child whose femur had shattered clean through the skin. His gloved hands were still shaking, and you wanted to say something—something decent—but the next gurney was already coming in, and someone was shouting for an airway and suction, and the moment was gone.
Then the doors opened again.
You heard the change in the room before you saw who it was.
There was a shift—like the sound dropped an octave. Like gravity changed hands.
A firefighter came in.
He wasn’t screaming.
He wasn’t saying anything.
That was worse.
Frank was wheeling him, and the medic at his side looked fucking wrecked.
“Flash burns,” Frank shouted. “Second and third degree, neck down to his hip. Helmet took most of the blast. He was on top of the truck when it popped the second time.”
“Vitals?” Joel asked, already snapping on gloves.
“Dropping. BP’s shit, O2 sat’s low 90s. He needs fluids, airway’s tightening.”
The man’s skin was cracked, dark, curled. Parts of it bubbled, weeping plasma.
“Get him to Trauma One,” Joel barked. “You—” He pointed to Ellie, who was two steps away. “Get Respiratory down here right now.”
“He’s trying to talk,” you said, leaning in.
You crouched beside the gurney as Frank slowed it beside the trauma bay. The firefighter’s lips were blistered. His voice was gravel.
“My…my wife’s here…”
“We’ll find her,” you said. “But you need to stay with us, alright? You’re at Austin General. You’re safe.”
He blinked slowly. “It hurts.”
“I know. I know it does.”
“Push fentanyl, IV,” Joel said, already cutting away what was left of the turnout gear. The skin underneath peeled off with the fabric.
“Motherfucker,” he growled, tossing the gauze aside. “This is third-degree over at least thirty percent. Get the burn team on standby.”
Tess appeared at your side with two nurses and a trauma surgeon. “Ortho’s full upstairs. Trauma Two is open but we’ve got a bleeding scalp lac in there. I’ll switch ‘em if we stabilize him in the next ten.”
You nodded. “I’ll start cooling compresses now.”
You grabbed a silver-coated burn dressing, opened it, and started gently laying it over the exposed tissue. The firefighter didn’t even flinch.
That was the worst part.
The not flinching.
Then came the second shift in the air. The kind you only felt a few times a year.
The doors opened again.
A uniform came through.
Police.
Dragging another.
The cop on the gurney was groaning, blood pouring from a shoulder wound, his vest soaked through, cheek torn open. One of his boots was missing. There was soot on his face.
Joel looked up. Groaned. Loudly.
“Fucking great,” he muttered, wiping his hands on a towel. “Just what we fucking need.”
You barely caught your laugh before it escaped. It wasn’t funny. But it was also so goddamn Joel.
Because whenever a cop rolled through the trauma bay, it meant one thing, the rest of the department was about to show up.
And they’d be in the ER. Hovering. Pacing. Armed.
It turned your trauma bay into a political minefield.
And Joel? Joel didn’t play that game.
“Officer was helping crowd control during the blast,” Tommy reported, voice clipped, wheeling the officer in beside Tess. “Got hit with some shrapnel and then trampled.”
“Vitals?” Joel asked, walking over.
“Stable. But barely. Pressure’s borderline. Laceration on the scalp, and that shoulder’s fucked.”
The officer groaned. “I’m fine.”
“You’re not fine,” Joel said. “You’ve got a puncture wound half an inch from your subclavian artery, and you’re actively bleeding onto my floor. Shut up and let me work.”
You stepped in behind him, grabbing gauze, gloves already on. “Do you want me to start a second line?”
“Yes. Left AC. Jesse—clamp this.”
“I’m clamping, I’m clamping,” Jesse muttered, hands bloody.
And right on cue, the cavalry came.
Five more officers entered the ER like they owned the place, guns holstered, expressions hard. They didn’t say a word, just hovered outside Trauma Three like sentries.
Dina appeared at your side with an exhausted expression. “I’m going to need a Xanax just from looking at this testosterone.”
“They’re gonna breathe down our necks until this guy’s transferred upstairs,” you muttered, snapping the catheter into place.
Joel didn’t even look up.
“Hey,” he barked, without turning. “One of you pacing jackasses wanna be useful? Go get your boy’s blood type from dispatch and stop fucking crowding my hallway.”
A few of them stiffened.
One opened his mouth.
Joel glared.
The cop closed it again.
Marlene slid in beside you with an extra tray. “You want me to log this guy’s injury for the report?”
“Document it for surgical,” you said. “He’s not going to need an incident report if he bleeds out on the floor.”
“I heard that,” the officer mumbled.
Joel leaned over him. “Good. Maybe you’ll listen better now.”
And then, somehow, like some cruel joke from above, a sixth cop walked in carrying a teenage girl with a bruised face.
“Hit by a rocket while filming a TikTok,” he said. “She’s got glass in her cheek and maybe a concussion.”
Joel blinked.
“Riley. That one’s yours,” he said.
“Me? I—I've never done this before—”
“You’ve got me,” Joel barked. “She’s stable. Triage her. I’ll double-check your assessment before discharge.”
You caught his eye.
You didn’t say anything.
You didn’t have to.
You could see it in him—the storm building behind his ribs. The fire that never quite went out. Joel wasn’t just in charge. He was containing the whole fucking hospital with the force of his will.
And still—when his eyes met yours, something shifted.
His jaw relaxed. Just a fraction.
You wiped sweat off your brow and nodded.
He didn’t nod. He just looked at you.
You pressed your glove to the officer’s wound and let yourself feel his gaze for one more second before the chaos swallowed you whole again.
It was four-thirty p.m. now. Or close to it.
The firework truck disaster had slowed—not ended, not resolved, but dulled just enough that you could hear your own breathing again. Maybe even someone else's. EMS was still ferrying in stragglers from the blast radius, but the heavy flow was stemmed. Controlled. Stitched and stapled back into some semblance of order by a crew of exhausted, bloodstained healthcare workers who hadn’t took a break since sunrise.
The ER was open again. Technically.
The triage desk was back on, the phones buzzing, the automatic doors kissing open with every new patient. The city hadn’t paused just because a truck of illegal fireworks blew up across the street. This was Austin. People still choked on hot dogs, burned their hands on grills, took edibles they didn’t understand and panic-texted their exes from Exam room 2.
And every. Single. Fucking. Room was full.
Overflow was full.
Trauma bays were full.
Peds, Ortho, Neuro, Med-Surg, Hall Beds 1 through 5, and the goddamn family bereavement room were full.
You were treading water, heart beating in your ears, sweat soaking your scrubs. There were two paper cups of coffee you hadn’t finished and three patients you hadn’t followed up on yet. Ellie was at the nurse’s station reviewing a chart with one hand and eating a banana with the other, eyes glassy from too much input. Riley had just returned from the stairwell, where she admitted to crying for two minutes, washing her face, and then saying I can do hard things.
That was you during your first year too. 
You hadn’t even taken your gloves off for the last hour. At some point, they just fused to your skin.
But then it happened.
The way it always does.
Sudden.
Loud.
Violent.
The radio crackled in from EMS. The voice was fast, panicked.
“Male, mid-thirties, penetrating chest trauma, left thoracic cavity—multiple stab wounds—no pulse for the last thirty seconds. We’re two minutes out—we’re performing compressions en route but he’s—he’s tanking.”
There was silence for one breath.
Just one.
Then Joel’s voice, low and lethal from the trauma bay, “Clear Trauma One. Now.”
You dropped the file in your hands onto the desk.
Tore off your gloves.
And you ran.
By the time you got to Trauma One, Joel was already there—mask on, arms scrubbed to the elbow, gown halfway tied. His jaw was clenched, eyes scanning the crash cart like he was inventorying a fucking battlefield. The room smelled like sweat and sterile burn cream, and still, something in the air cracked open, the second you stepped in.
Not panic. Not fear.
Something heavier.
Something that whispered this one’s gonna be different.
“Get them all in here,” Joel snapped to Marlene, who stood at the door. “Everyone. Jesse, Abby, Mel, Riley, Henry. Ellie too.”
“They’re not all on rotation for—”
“I don’t give a fuck,” he barked. “They want to work in the field? They want to become doctors? They watch. They help. They need to see this.”
You stepped in beside him, already pulling on a new pair of gloves. “Is it…?”
Joel looked at you. Really looked.
And when he nodded, your pulse jumped.
“Emergency thoracotomy,” he said. “If he arrests, we crack the chest.”
Your heart stuttered.
This was it.
This was the thing you’d been obsessing over for months—talking Joel’s ear off about it over half-empty glasses of whiskey at his kitchen counter, watching old procedural videos while curled up next to him in bed, asking him over and over what was it like the first time you did one? Did it work? Did it feel real? He never answered in full. He just grunted, or said “bloody,” or told you to go the fuck to sleep while he digs his head back into your warm neck.
And now it was happening.
And he was here.
And you were ready.
The doors burst open.
The paramedics wheeled him in at a dead sprint. Literally. Because the man on the gurney was dead.
Pulseless.
Agonal.
The first medic was shouting, “We lost him for thirty—make that forty seconds now. GSW to the chest, left thorax, suspect a knife. Maybe a piece of pipe. Whatever it was—punched straight through.”
Joel was already at the bedside, yanking off the sheet.
You followed without needing to be asked.
“Jesse, get vitals on monitor. Abby, you’re on line. Riley, grab the thoracotomy tray. Henry—”
Henry paled. “Yeah?”
“Don’t fucking faint again.”
“I won’t.”
“You faint, I leave you there.”
He nodded. Swallowed. Backed up.
The man’s skin was waxy. Blue around the lips. The gaping chest wound glistened and bubbled with thick, frothy blood—the worst kind. Pulmonary. Wet. Final.
“We’re cracking,” Joel said to the room. “Now. He’s not coming back with compressions. We open.”
Ellie blinked. “You mean like—like open open?”
“Like ribs-on-display open,” Joel snapped. “Don’t move unless you want your shoes soaked.”
And then—Joel turned to you.
Paused.
Looked at you with that sharp, knowing edge that said this is the moment you've been waiting for.
“Do it,” he said.
You blinked. “Me?”
“You’ve been begging for this for six fucking months. Talking my ear off. You want it—take it.”
The room froze.
Everyone stared at you.
“No pressure,” Mel whispered. “Just someone’s life on the line.”
You didn’t blink.
Didn’t flinch.
You stepped forward, and you cracked his fucking chest.
Joel guided, hands over yours, voice low but never soft. “Midline. Left thoracotomy. Rib spreader. Go now.”
Riley handed it over with trembling hands. Abby dropped suction tubing on the floor and didn’t even pick it up.
You made the incision.
Deep.
Fast.
Confident.
The blood poured.
Joel caught it.
Jesse cursed under his breath. Ellie made a sound like she was swallowing vomit. Henry straight-up whimpered.
You cut through the muscle.
Joel barked again. “Keep going. Don’t stop until you see the goddamn heart.”
You spread the ribs. The crack was wet and obscene and louder than you expected.
It wasn’t like TV.
It was real.
Inside, the left lung was collapsed, the pericardium filling with blood.
You could see the heart.
And it was still.
Joel didn’t say anything.
You didn’t need him to.
You reached in.
Your gloved hand slid into the cavity like a blade. Warm. Tight. Full of potential.
And you found it.
The heart.
“Massage it,” Joel said. “Rhythm. Controlled. You’ve got this.”
You started compressions—internal. Thumb and fingers. Slow, then faster.
Riley was in the corner, trying to stand tall. 
Abby whispered something that sounded like a prayer.
Mel had gone quiet, which was somehow worse.
Henry was gripping the counter, white-knuckled.
Jesse stood frozen until Joel barked at him to bag the fucking patient.
And you—you were the one keeping the man alive.
For ten seconds.
Then twenty.
Then thirty.
Then—
Beep.
Faint.
Then stronger.
Joel leaned over the monitor.
“Sinus rhythm,” he said, eyes flicking to you. “Goddamn. You got him back.”
A gasp filled the room.
Abby nearly dropped her syringe.
Mel exhaled like she hadn’t breathed in minutes.
Jesse muttered “holy shit.”
Ellie said, “you just—he was dead. And now he’s not.”
Joel looked at you.
Just for a second.
And his face didn’t soften.
Not quite.
But his jaw relaxed. His eyes cooled.
“Good work,” he said, voice like gravel. “Now close him up.”
You did.
You fucking did.
You closed him. The room moved around you—cleaning, charting, reeling—but you stayed still. Hands deep in blood. Covered in it. Gowned and soaked and shaking just a little.
Joel stepped up beside you.
“Looks good,” he said.
You turned.
“Did I do it right?”
He didn’t answer. He didn’t need to.
He just nodded once.
A single, hard nod that meant more than words ever could.
Everyone else eventually left. One by one. Except Joel.
When it was just the two of you, he reached out and wiped a streak of blood from your cheek with his gloved thumb.
“You’re disgusting,” he said.
You grinned, breathless. “So are you.”
“Don’t let it get to your head.”
“Too late.”
He rolled his eyes.
But then, under his breath, like it wasn’t meant for anyone else,
“Proud of you.”
You almost missed it.
But you didn’t.
You never did.
Because it was Fourth of July, and the world outside was still burning.
But inside this room, for just one breathless moment—
You had brought someone back to life.
And Joel fucking Miller had watched you do it.
And he wasn’t going to forget it.
Joel Miller didn’t say things twice. If he was proud of you, that meant something. That meant everything.
You peeled off your gloves and stepped out of Trauma One with the sting of adrenaline still buzzing under your skin. Your hands trembled slightly—not from fear, but from the absolute goddamn power of that moment. You’d cracked a chest. You.
And Joel let you. Trusted you.
That kind of trust didn’t come easy from a man like him.
It was 5:00 p.m.
One hour left.
You told yourself you’d make it. You could do another hour. You’d get through whatever the Fourth of July still had left to vomit into your ER. You’d go home, peel off your scrubs, crawl into Joel’s bed, and maybe—maybe—you’d even get to fall asleep with your face buried in his neck before another fucking Code Blue ripped through your subconscious.
You turned the corner and nearly ran into Kathleen, who stood like a weathered pillar of war-torn exhaustion at the nurse’s station. Her face was flushed, arms crossed, brows pulled into a flat, unimpressed line.
“There’s a call for you,” she said. “Line two. Marlene has it.”
You blinked. “Someone called me?”
Kathleen didn’t blink. “Apparently it’s urgent.”
You stared.
She didn’t explain.
Marlene handed you the receiver with the grace of someone physically holding back a cackle.
You pressed it to your ear. “This is—”
“Thank fuck.”
Owen’s voice. Too loud. Too fast.
“Owen?”
“Hey. Yeah. Hi. Listen—I need a huge favor. Massive. I’ll owe you a kidney or three consults, I don’t care, just—please, can you cover the first three hours of my shift?”
You glanced at the clock.
5:01 p.m.
“I’ve been here since five this morning.”
“I know. I know. You’re a goddamn hero. Literally Jesus in black scrubs. Just—three hours. Please. Just until nine. I’ll come in at nine. Nine sharp. Not even a minute late.”
“Why?”
There was a pause.
And then, “I wanna have dinner with Mel.”
You inhaled slowly.
“Seriously?”
“I made a reservation,” Owen said, like that was somehow a valid excuse. “At the fancy new restaurant, the one Joel took you to. I bought cologne. I haven’t eaten real food in two weeks.”
You turned to look behind you.
Abby was standing by the vitals board, arms crossed, trying not to look like she was listening.
But she was.
And her face had gone tight in that way you recognized—the jaw-clench of someone pretending they don’t care.
Shit.
“Owen,” you said carefully. “This is your shift. You’re scheduled. You’re—”
“I’ll trade you! Anything. I’ll do your whole weekend. I’ll take all your psych evals for a month.”
“That’s a bold offer.”
“I’ll clean the vomit buckets in the peds trauma room!”
“You should already be doing that.”
“I will now.”
You sighed. Rubbed your forehead. Glanced at Abby again. She was now fake-charting on a blank clipboard. Poorly.
You shouldn’t do it.
You knew you shouldn’t.
But then Marlene handed you a new chart—incoming trauma. Level 1. ETA five minutes.
“Goddammit,” you muttered. “Fine. Three hours. But you owe me your soul.”
Owen cheered on the other end.
You hung up and looked over at Abby.
She didn’t look up.
You stepped closer. “Hey.”
“I’m fine,” she said. Immediately. Too quickly. “Totally fine. Not my business. Not even my night. Just…you know. Cool. Love that for them.”
“Abby.”
“I said I’m fine.” She slammed the clipboard on the desk and walked off, her ears visibly red.
You sighed again.
Before you could process any of it, a stretcher screamed into the trauma bay.
Tommy was at the head, barking orders, and Frank had blood on his shirt again—big surprise.
Teenager. Male. Fourteen, maybe fifteen. Slumped over. Screaming.
“Lawnmower accident,” Frank snapped, pushing hard. “Fucking dad didn’t check his blade height—hit a rock, launched it like a missile.”
“Penetrating orbital trauma,” Tommy added. “It hit the kid in the eye. He’s bleeding like hell. Not responsive.”
Jesse was already snapping gloves on beside you. “Tell me that rock didn’t puncture the fucking globe.”
You moved to the side of the bed as the kid’s head rolled. His left eye—Jesus fuck—his left eye was gone. Or at least it looked like it. Crushed inward, blood and viscous fluid pouring down his cheek.
Riley gagged.
Mel paled.
Abby reappeared beside you, full fury now replaced by full panic.
“What the fuck,” she muttered. “People should need a fucking license to own a lawn.”
“Vitals?” Joel’s voice cut through the trauma room as he entered, already gloved, already dark-eyed and tense.
“BP dropping,” Jesse said. “Heart rate climbing. He’s crashing.”
“Jesse, get a line,” Joel barked. “You—” he pointed at you. “Ocular tray, now. I want that eye covered. He so much as twitches and the optic nerve’s gonna shear.”
You grabbed the tray from Riley’s shaking hands. “We’re sedating?”
“If I don’t, he’s gonna start fucking thrashing and drive that rock deeper into his skull.”
The father—still in a goddamn polo shirt and sandals—stood at the door, blood on his arms, face pale.
“I just wanted to mow the yard before the guests came,” he kept whispering. “We were gonna grill—he was helping—I just—”
“Sir,” Joel said coldly, without turning, “if you don’t shut up, I’m going to have you dragged back into the waiting room.”
The dad shut up.
You placed the rigid eye shield over the wound. Blood pooled around the edges. It was already soaking the pillow. The kid groaned, twitching.
“Don’t move,” Joel growled. “Do not fucking move.”
“He’s coding,” Mel snapped. “BP’s bottoming out—seventy over thirty.”
“We need a cric tray ready,” Jesse said. “I can’t get the O2 past the swelling.”
You were moving, hands slick, adrenaline high and sharp.
Joel grabbed the ultrasound probe. “FAST scan. I want to rule out abdominal trauma while we stabilize the head. If that rock skipped through—”
“It didn’t,” Tommy said grimly. “We found the fucking thing in the driveway. Looks like a meteor.”
Joel’s hands moved fast. Surgical. Terrifying.
You mirrored him. Fast. Exact. No room for error.
This wasn’t like the thoracotomy. This was slower. Messier. No clean incisions here. Just trauma. Raw and violent. The kind that steals things. Childhood. Sight. Fucking Fourth of July barbecues.
Abby pressed gauze to the kid’s neck. “He’s tachycardic. We need to intubate.”
“I’ll do it,” Joel said, snapping his fingers. “Get the tube. Bag him. Suction ready.”
“You want me on airway?” you asked, stepping in.
He looked at you. That same look from earlier.
“I trust you.” he said.
So you did it.
You took the tube. You got the line. You shoved the fucking endotracheal tube into a kid who just lost his eye and might still lose his life. You did it because you had to. Because no one else could.
And because Joel trusted you.
You bagged until the O2 sats climbed back out of hell.
Mel ran labs.
Riley got a chest film.
Abby called Ophthalmology.
Jesse finally got the dad escorted to the waiting room by Bill before Joel could murder him with his stare alone.
Joel stood at the foot of the gurney, arms folded, eyes dark and burning.
“He’s stable,” Jesse said, breathless.
“For now,” Joel muttered. “Get imaging. Stat.”
You leaned over the bed, wiped some of the blood from the kid’s temple.
And then you felt Joel behind you.
Close. Not touching. Just there.
“You did good,” he said, low, just for you. “Again.”
You turned slightly, eyes meeting his.
“You keep saying that,” you murmured.
“That’s because it keeps being true.”
And then he was gone.
The kid was wheeled to CT.
You turned to the trauma team, who were collapsing one by one against the wall, soaked in blood and sweat and the sheer weight of almost.
Ellie looked ready to cry. Riley was holding a juice box. Jesse was on his second bottle of water and muttering something about moving to Canada. Abby was pacing, muttering Owen’s name under her breath.
And you?
You checked the clock.
5:43 p.m.
You still had two hours and seventeen minutes left in the shift you weren’tsupposed to work.
And already, it felt like a whole new fucking war had begun.
You cracked your neck. Wiped your forehead. Took a deep breath. And turned toward the doors.
Another stretcher was rolling in. Because of course it was.
Happy Fucking Fourth of July.
It was six when the first wave of soldiers walked off the battlefield.
The day shift clocked out like they were fleeing a warzone—scrubs stained, hair plastered to their foreheads, eyes too wide and hollow to belong to people under thirty. The fluorescent lights had aged them by decades. Some had blood on their shoes. Some had blood in their hair. Some weren’t sure whose blood it was.
Kathleen passed by the desk with her bag over her shoulder, muttering, “If they page me before five tomorrow, I’ll set this place on fire.”
Jesse was limping, dragging one foot behind him like a wounded animal, sipping a smoothie someone handed him two hours ago that had fully liquified into soup. He waved weakly in your direction, eyes dead. "Don't let anyone else swallow a flag," he said. "Just… don’t."
Ellie was practically vibrating on her way out, holding a foil-wrapped bundle that had been a brownie Dina was eyeing earlier. “I’m gonna eat this and then sleep for six days,” she told Riley, who was chewing on ice like it was a coping strategy.
Dina had her phone pressed to her ear, her free hand gesturing wildly as she talked to some poor soul on the other end. “No, I can’t go out tonight, I literally watched a baby eat gunpowder. Yes, literal gunpowder. Like from a firework. I don’t care if it’s rooftop karaoke, I’m not fucking going.”
Mel, fresh scrubs on now but still blotchy from everything, lingered at the front with her bag slung low and her hair half-down. She spotted Dina and beamed like the sun hadn’t just tried to kill everyone inside the ER.
“I’m serious,” Mel gushed, linking her arm with Dina’s as they walked. “Owen made reservations. He was so sweet. I think he even bought a new shirt. He didn’t say it, but it wasn’t wrinkled, so that has to mean something.”
Dina snorted. “Wow. A man wearing a clean shirt. You better marry him.”
You weren’t listening on purpose.
You just…couldn’t not hear it.
Because Abby was two steps behind them, standing by the elevator bank, still in her half-zipped hoodie and Crocs, staring at the tiled floor like she could melt through it.
You stood near her.
Close but not close.
She noticed you before you said anything.
“I’m not gonna cry,” she said flatly. “So don’t say something nice.”
You shrugged. “Wouldn’t dream of it.”
“Good.”
She paused.
Then, quietly, “Did you know?”
You didn’t answer. Because you had. Of course you had. The way Owen had started standing closer to Mel. The way he’d brushed Abby off the past two weeks with half-assed excuses.
“I’m not mad at her,” she said, still staring forward. “I mean…maybe I am. But it’s not like she knew.”
You leaned next to her against the wall. “You don’t have to be fine.”
“I know.”
“I’m not fine either.”
She nodded.
And that was enough.
The elevator dinged.
She got in.
Didn’t look back.
You stayed in the hallway for a beat longer, the hum of overhead lights buzzing in your teeth. Your eyes were dry and scratchy. Your hands smelled like latex. There was blood on the cuff of your sleeve again, and you didn’t even remember who it belonged to.
The night shift was officially here now.
Soon the night staff began pooling into the ER.
They shuffled in with the kind of dead-eyed resignation of people who knew exactly what they were walking into. They looked at you with curiosity, confusion.
“You're still here,” one said.
You just nodded. “Still am.”
The ER had quieted in the way a battlefield does after the airstrikes stop—still full of smoke, rubble, and bodies, just… quieter. The screams were fewer. The alarms less frequent. But the stench of bleach and burnt flesh still clung to the walls.
You were working a bay in the corner, checking on a man who’d driven straight into a ditch after swerving to avoid a firework that had launched into the road.
“Wasn’t even my firework,” he mumbled, a gash splitting across his temple, blood matting his hair. “Some asshole two blocks over. Guess they didn’t like my truck.”
You were scanning for signs of concussion, clicking the penlight, asking about nausea, when he squinted at you.
“You’re cute,” he slurred. “Like real cute. Do you—uh—do you always look this good when you save lives?”
You didn’t answer.
He tried again.
“You got a boyfriend?”
You snapped the light off and looked him dead in the eye.
“I’ve got a scalpel,” you said.
He laughed.
You didn’t.
Across the ER, you heard a sharp voice bark, “You’ve gotta be fucking kidding me.”
Your heart skipped.
Joel.
He was back.
Fully suited in trauma gear again, hair still damp with sweat, scrub top stretched over tense muscle. His eyes were already narrowed, fixed on you.
You didn’t even see him walk over—he was just suddenly there, all heat and static and restrained violence. He looked down at the chart in your hand, then up at your face, then over at the patient who still hadn’t stopped smiling.
“What the fuck are you doing?” Joel said, voice low and lethal.
“I’m working,” you said, frowning. “Owen called and asked me to cover—”
“Owen’s a fucking idiot,” Joel snapped. “This isn’t your shift.”
“He begged. He wanted to—”
“See Mel. Yeah, I fucking heard.”
Joel looked down at the driver again, eyes narrowing. The man blinked at him like he wasn’t sure if he was about to be murdered or offered another morphine drip.
“Go,” Joel growled. “Get the fuck out of here.”
“I’m almost done.”
“No. You’re not.”
He stepped forward, crowding your space. Not touching, but too close. His presence filled your lungs like smoke.
“I didn’t let you walk out of that trauma room with your hands inside someone’s goddamn chest just to have you stay late because some piece of shit didn’t want to miss his fucking dinner reservation.”
“I said I’m fine—”
“You’re not. Your face is pale. Your knees are shaking. You’re bleeding from your neck again—”
You touched your collar.
Shit.
The scratch had reopened.
Again.
You hadn’t even noticed.
Joel’s voice dropped lower. Quieter. More dangerous.
“You stay here another hour, I’m not gonna be able to stop myself from saying and doing something that gets me fired.”
You swallowed.
“You need someone to finish the chart.”
“I don’t need anything but you out of this hospital and in my bed before I fucking lose it.”
You blinked.
His eyes locked on yours.
“This isn’t up for debate.”
He turned to the driver without breaking eye contact.
“She’s off,” Joel told him. “She doesn’t work for you. You want someone to hold your hand and stroke your ego, call your fucking wife.”
The man gaped.
Joel turned back to you.
And this time—softer, just slightly—he added, “Go home.”
You didn’t argue.
Because he wasn’t asking.
You peeled your gloves off. Dropped them into the bin.
Your scrubs were soaked. Your throat burned.
And for the first time in hours, you realized how goddamn tired you were.
Joel’s eyes followed you until you reached the staff hallway.
And you could feel the heat of them still burning between your shoulder blades as you stepped into the elevator—
Finally, finally—
Done.
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daddydindjarin · 1 month ago
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Chapter 1: After Midnight
Dr. Michael "Robby" Robinavitch x f!Reader Rating: M- nothing in this post, but it'll get there, so we're going to mark all the shots as M. A/N: The way this show has sparked my imagination back into full gear is absolutely insane. I've not been able to get these characters out of my head, and the FMC feels like she jumped into life fully formed. If it wasn't for @lowlights and @write-and-buried I wouldn't have had the courage to write or post so I'm so thankful for them listening to my ramblings about these dorks. And as always, the dividers are by @firefly-graphics
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PTMC Emergency Department, 2:13 a.m.
You’ve been at Pittsburgh Trauma Medical Center for eight years, and the hospital hums in your bones by now. You started here as an intern, matched fresh out of UNC Chapel Hill, more nerves than skin. Somehow, you stayed—intern year, residency, boards, senior year peds elective that cracked something open in your chest. Now you’re two years into a pediatric emergency medicine fellowship, and you’re still covering every inch of the ER. Peds. Adults. Whatever rolls through the ambulance bay.
You’re good at it. Everyone says so.
It doesn’t make tonight easier.
The air smells like vomit and bleach, and the kid from North 2 coded in triage before you even touched him. Seized twice. You got him back, got him upstairs, but it took something out of you. Something you’re pretending you didn’t need.
The charting desk blurs in front of you, your fingers hovering uselessly over the keys. Your body is moving because it has to, but your brain…your brain’s somewhere else. Blank. Fuzzy. You’re wearing betadine on your sleeve like a medal, your hair’s half out of the tie, and your stomach’s been twisting empty for hours.
The paper coffee cup appears like a miracle.
You blink. Steam curls gently into the fluorescent light and you can smell the sugar before the coffee, and you know, one sugar, no cream- exactly the way you drink it when you’re too tired to argue with yourself. The hand that brought it disappears from your periphery, and when you glance sideways, Robby is already leaning against the counter.
He’s still in scrubs and a half-zipped jacket, sleeves pushed to his elbows. His hair is messy in that way that it only gets after he’s run both hands through it four times in a row. He signed out hours ago.
“You looked like you were about to fall off the stool,” he says, as if it explains anything about why he’s suddenly here.
He places something else on the desk, and the crinkly yellow packaging is immediately recognizable. It’s a granola bar- oats and honey, your favorite, and he doesn’t even say anything about it. Just places it on the counter like he does this every night.
You take it without thinking, not bothering with a thank you. You’ve known him too long for that. Since your intern year, when he used to watch your traumas like he was waiting for you to sink or swim. Robby never said much during those moments. Just handed you gloves, tied your gown for you when your hands were shaking. Once, when you were crying in the stairwell after a loss, he said, “You stayed. That mattered.” You think about that more than you should.
He was the first one you left a sticky note for.
You’d written a question on a chart you felt dumb about- basic trauma math, something you already knew but doubted yourself on anyway- and you drew a little cat beside it, giving a thumbs up. You meant it as a joke, a little self-directed kindness. You didn’t expect a reply.
Later that day, your chart came back with a short answer and a doodle of a matching cat, this one with a stethoscope.
You’ve been trading them ever since. He doesn’t know you save them all.
“You’re off shift,” you murmur around a bite of granola.
He shrugs. “Dropped something.”
You raise an eyebrow. “You dropped something six hours ago and came back for it now?”
“Wasn’t important ‘til I realized it was gone.”
You snort. He doesn’t smile, but his mouth twitches at the corner. You sip the coffee (still hot, thankfully), and you try not to wonder how long he stood in the staff lounge waiting for it to finish brewing. How long he watched the monitor board before walking over.
His knee knocks yours under the desk, light, unthinking. He doesn’t move away. Neither do you.
“You finishing notes?” he asks.
You nod, resisting the urge to scrub your face. “Trying.”
“You want help?”
It’s a soft offer. He already knows the answer- you always finish your own charts. But you shake your head and smile anyway, just barely, because the question still matters.
You both go quiet. Not awkward, just familiar. There’s a hum to it, like a routine you’ve both walked into without planning. He doesn’t speak again, just leans on the counter beside you while you finish chewing and try not to let your hands shake on the keyboard.
And when you shift sideways, just barely, just enough for your arm to rest against his, you don’t say a word.
He doesn’t move away.
Five minutes later, the granola bar is gone, and so is the worst edge of your headache. You’re not okay, exactly, but the world feels a little more manageable with him nearby. A little less like it’s closing in on you from all sides.
You start typing slowly, your fingers still stiff, but moving now. The chart is basic enough- chest retractions, fever, positive RSV. You double-check your med orders, update the time of transfer to PICU, then hit sign and save. It only takes two minutes, maybe three, but he stays through all of it.
When you look up, his eyes are on you.
Not watching you work. Not judging. Just… there. Steady. Present.
You lick the granola dust off your fingers. “You really came back for something you dropped?”
He lifts a shoulder like it doesn’t matter. “Something like that.”
You let the silence stretch between you. There’s a smudge of blood on your sleeve you hadn’t noticed until now- faint, rust-colored, streaked across your cuff like it didn’t want to be remembered, and you tug it down over your wrist.
He notices. Of course he does.
“You need a break,” Robby says. It isn’t a question.
“I need to finish notes.”
“You’ve been sitting in the same spot for twenty minutes and finished one.”
You roll your eyes, but he’s not wrong. You’re only half here. The rest of you is still in that trauma bay, still hearing the mother’s voice break when her toddler stopped seizing and went limp in her arms.
He shifts closer, subtle but unmistakable. “Come on.”
“I’m on shift.”
“You’ve got five minutes. I’ll cover.”
You almost laugh. “You’re not even on tonight.”
“I think I can cover you in my ER for 5 minutes,” he says, already turning like he plans to guard the door if Jack comes looking.
You glance toward the break room. “You just want the last of the good coffee.”
He arches an eyebrow. “You saying you didn’t want the one I made you?”
You’re not sure how to answer that. The truth is, yes, you did want it. You always want things from him that you don’t know how to name.
You stand as if it were never even a question, following him towards the break room.
The hallway is dimmer here, further from trauma. The sound of suction and crying recedes behind you as you push open the door to the staff lounge. It smells like someone’s burned popcorn and someone else’s vanilla lotion. There’s a half-full pot of coffee on the warmer and a chair in the corner with your name on it. Not literally, but it’s the one you always take when your legs give out halfway through a double shift, and tonight is no different as you collapse into it.
Robby follows you in. He doesn’t sit, just leans against the counter and pours himself a cup- like it’s his personal kitchen, like this is just another shift you’re working together, not some strange middle-of-the-night orbit you’ve both chosen to fall into.
“How’s Abbott?” you ask, assuming correctly that Robby had stopped to see him before finding you. You’d seen him come in at 7 when you started your second half of your double, but not since, attesting to how busy the pit always stayed.
Robby sips. “Still teaching residents how not to kill people.”
You grin. “So angry, but effective.”
He nods. “And bored out of his mind. He said to tell you that if you don’t start bringing muffins for night shift again, he’s going to start baking his own, and no one wants that.”
You let your head fall back against the chair, choosing to ignore the fact that Jack knew Robby would find you. “I’ve created a monster.”
Robby snorts. “More like unleashed one. Abbott’s been talking about buying an apron. Pink. With ruffles.”
You laugh, sharp and sudden. “If that man bakes half as well as he burns through residents, I’ll be out of a hobby.”
Robby leans back, arms crossed. “Guess you better get back to baking, then.”
You grin. “Maybe I will.”
His eyes flicker down to your hands. He doesn’t say anything, but his mouth curves, just barely. It makes you feel warmer than it should.
He sets his cup down. “I’m gonna grab a blanket. Don’t move.”
You watch him go.
The moment he’s out of the room, your chest tightens like you’ve been holding your breath. You don’t know what to do with yourself. You never have, not around him. It’s been years, and still this soft ache in your chest hasn’t dulled. You told yourself it was a crush. Told yourself it would fade once you stopped needing his approval, once you finished residency, once you got your fellowship, once you found something real.
But he keeps showing up with coffee. Keeps remembering what you like. Keeps bringing granola bars without asking.
And you keep saving every damn sticky note he leaves you.
You’re still thinking about that when he comes back in, a thin fleece blanket in his hands, and he tosses it toward you. It smells like the linen closet. A little like him.
“Five minutes,” he says, settling into the chair beside yours. “Close your eyes.”
You do. Just for a minute. Maybe two.
And when you feel your head start to fall sideways, when you feel your temple brush his shoulder and he doesn’t shift away, you let it happen. Just for five minutes.
The blanket is thin and hospital-issued, scratchy in the corners, but it’s warm. You pull it tighter around your shoulders, feet tucked under yourself in the awful break room chair you’ve collapsed into a hundred times. Usually alone and vibrating from caffeine and cortisol. Tonight, your pulse is steady. You blame the granola bar.
Robby doesn’t speak. He doesn’t shift, just sits there beside you, long legs stretched out, hands folded loosely in his lap like this is something the two of you always do.
You wake up, god knows how much later, to the sound of someone knocking softly on the lounge door.
Robby stirs beside you. You shift from where you’ve fully slumped against him without realizing it, your cheek sliding off his shoulder. He doesn’t move away until you do.
Kim pokes her head in without waiting, gently calling your name. “Five-year-old with an asthma flare in South Three. She’s stable but climbing.”
You rub your eyes, belatedly realizing you were smearing your mascara. “On it.”
Her gaze flicks to Robby, eyebrows arched. She doesn’t say anything, but you can read her smirk like it’s printed on a chart. You’ve been on the receiving end of enough nurse gossip to know when you’ve just handed them material.
“Thanks, Kim,” you say, voice scratchy. She disappears, and you stand, stretching out your back, wincing at the pins and needles in your feet. Robby stands with you, slower.
You hand him the blanket. “Thanks. For this.”
He just shrugs. “Figured I owed you one.”
“For what?”
His mouth twitches, but he doesn’t answer.
You step out into the hall together. You should split off. He’s not on shift, you’ve got a patient waiting, but you hesitate for a second. There’s something about the quiet between you, the way it softens your jaw, makes the ache in your shoulders a little more bearable.
“Get home safe,” you say.
He says your last name like a secret kept between the two of you. “You too.”
He always calls you that when he doesn’t want to say something else.
You turn down the hallway toward South Three, and you don’t look back.
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You’re halfway to the locker room when the day shift rolls in like a slow, caffeinated tide.
Princess is the first one through the bay doors, still in her coat, coffee thermos under one arm, muttering about traffic on the Fort Pitt bridge. She spots you immediately and tsks your last name like a disappointed aunt. “You look like death and poor decisions.”
You grunt. It’s the most language you’ve got left in you.
“Did you even eat?” she asks, already digging into her bag. She doesn’t wait for an answer, just slaps a protein bar into your palm and points a perfectly manicured finger at your chest. “You will eat this before you drive. Swear on my ovaries.”
“Your what now?” you mumble.
“Swear it.”
You nod, obedient and sleep-drunk.
Then Perlah breezes in behind her, laughing before she even hits the desk. “Don’t listen to her, ngulót, she gets dramatic when she skips breakfast.” She gently pinches your cheek on the way past. “You okay?”
“Pulled a double,” you say. “Still standing.”
“Barely,” she mutters, and reaches out to fix the collar of your fleece, hands warm and quick. “You going home or collapsing in the on-call room again?”
“Home. I think.”
“Good.” She leans close and whispers, “Jack left twenty minutes ago. Said if you didn’t get out soon, he was coming back to carry you.”
You snort. “Sounds like him.”
“Did you tell her what he called that kid in trauma last night?” Perlah asks Princess, eyes alight.
“Oh my god, yes. ‘Little bastard’s lungs are doing a samba.’ Right in front of the mom!”
You groan into your hand. “Why do we let him near people?”
“Because he saves them,” Dana answers from behind the triage desk, voice steady as always.
You turn, don’t even remember pivoting, and there she is. Reading the board like she can feel which rooms need her without walking in. Her eyes flick to you and hold.
“You’re still here?” she asks, not unkind.
“Just leaving.”
She nods once. No fuss. No scolding. “Go. Rest. You’re no good to me burnt out.”
It’s the closest she’ll come to I worry about you.
You clutch the protein bar a little tighter.
Then there’s a shift in the air.
You don’t hear his footsteps, but you feel him.
Robby’s voice calling your last name is somewhere behind you, low and easy: “Morning.”
You turn.
He’s in a clean set of scrubs, hair damp from a shower, badge clipped to his collar. He smells like eucalyptus shampoo and maybe cinnamon. You don’t know what to do with your hands, so you stuff them in your pockets.
“Morning,” you say.
He walks past you toward the desk, nodding at Dana, fist-bumping Perlah, stealing Princess’s coffee without asking. Everyone’s talking around you, but all you hear is the echo of your head on his shoulder. The weight of the blanket. The heat of the coffee cup in your hand.
Robby glances back just once, mouth quirking. “Go home before you end up unconscious in triage and really get the pit treatment.”
You should say something clever. Something funny. Something like I could be unconscious anywhere, really. The on-call room, my room…your room.
Instead, you watch him walk away.
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It’s almost 6:45 a.m. by the time you leave the hospital. Pink is just bleeding into the sky over the Allegheny, and the wind cuts sharper than it did last week. You don’t have a hat, but you pull your coat tighter around you and keep walking toward your car, parked somewhere near the construction zone that’s been eating the south lot for months.
Your body is running on crumbs. You didn’t even realize how hungry you still were until you hit the air.
You unlock your car, slide inside, and grip the steering wheel with stiff fingers. You sit there for a long time just breathing. Thinking about the coffee. The granola bar. The way he didn’t even ask before handing it to you. Like he already knew.
You think about the first sticky note. The way he drew the little stethoscope on the cartoon cat. The way you stuck it in the pocket of your white coat and never took it out.
You think about his shoulder under your cheek. Solid. Warm. Unmoving.
You think about marching back into the ER where you know he’ll be clocking in soon, and asking him what he really came back for.
You don’t.
Next ->
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shinynewboots · 1 year ago
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Hazbin Hotel Characters as Medical Specialties
Charlie: Pediatrics
You're telling me can't imagine Charlie with Bluey stickers in her pocket and saying "oh I see a dog in your ear. Woof!" When using an otoscope on a child with an ear infection? Be so for real rn
Vaggie: Emergency Medicine
This woman thrives in chaos, she grew up on a battefield. The ED is the Wild West of medicine and Vaggie thrives under the constant stress and variety
Vaggie: "what do you mean you were woodworking while drinking, are you fucking stupid"
Vox: Nephrology
Okay, okay this one is less based in personality and more based in the fact that I need to see a pissing competition between Vox and Alastor (as a cardiologist) about fluid status and renal function
Vox: *decreases lasix dosage in a patient with poor renal function*
Alastor: *punches Vox bc that patient is also fluid overloaded and has heart failure with a reduced ejection fraction*
Velvette: Dermatology
Listen you can't tell me that she didn't have amazing skin when she was alive. I can see her moving more towards the cosmetic side of dermatology with occasional biopsy or Mohs bc who doesn't love a procedure every once in a while
Cherri: ICU/Crit Care
Like Vaggie, Cherrie also thrives in chaos and things in the ICU can go from 0 to 100 in less than a minute. I also feel like she would have pretty good empathy and separation of work and home to be able to not let the job get to her too much
Angel: Psych
This just feels perfect to me, more based on my own experience but everyone I've met in Psych is kind while also being the coolest person you've ever met. I also think Angel would really be able to empathize with his patients based on his own history with addiction. He really likes to listen and offer support and advice.
Alastor: Cardiothoracic surgeon or Cardiologist (to get into a pissing contest with Vox about fluid and sodium)
Look, I know Al is like the perfect surgeon. He's intimidating, meticulous, and calculating. And I don't disagree, I think he would thrive as a CT surgeon...however, there's just something about him arguing with the nephrologist that just gives me the giggles
Lucifer: Internal Medicine
Listen, he's done it all and seen it all. He will spend hours rounding because he just wants to make sure he gets everything right (he's also avoiding going home alone but that's a different story). He also loves working with medical students and will give rousing lectures on first-line antihypertensive and diabetes medications (while also getting all of the students and residents names wrong).
Lute: OBGYN
Listen, I love Lute but if I knew her in real life she would intimidate me so badly. Much like the OBGYN attendings I worked with. She's amazing at her job and beloved by her patients for her blunt yet realistic recommendations, but in her L&D room or operating room, that is her domain and there is no deviation from that. Medical students and residents should exercise caution, but she will teach them the most out of any rotation
Adam: Orthopedics
This man is an ortho bro if I've ever see one. He is the attending who will pimp medical students on the playlist he has playing in the OR instead of the surgery in front of them. (What do you mean you don't know what artist this is? It's the fucking Eagles. Go home and study up, we're playing Led Zepplin tomorrow.)
Niffty: Pathology
Listen I have no explanations for this one. It just felt perfect, tbh
Husk: Anesthesia
This man is like every anesthesiologist I've ever met. He is there stereotype and sits behind the current with his sudoku in hand. Don't let that fool you, this man has knowledge and skill and is not afraid to use. The second your patient starts de-sating or coding, he's the one you wanna listen to
Rosie: Family Medicine
Rosie is the picture-perfect family medicine attending. Kind, empathetic and offers great advice. From cradle to grave, she's got you covered with primary prevention and screening and will be there for you for whatever comes next
Lol this is meant in good fun, so there are a few stereotypes about the different specialties and a lot of it is based on my own experiences on rotations. Let me know what you guys think. I know I missed some characters so let me know if y'all want me to come up with more.
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comical-wheelchairs · 8 months ago
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The Oracle Code (2020) (Manuel Preitano) - 10/10
I know the DC graphic novels have a bad rep, but I recommend this one. It was a great read and I'm really happy it was created. Here's what's great about this chair:
The Frame/Chair
It's not a stretch to say Barbara's family has access to money/resources, and this chair is made very well for a person with a spinal cord injury who will be using it full time. It is rigid, making it lighter/better for full time use. The footplate is solid and the casters are small, but not tiny, making them great for things like getting around a city or grassy patches. The push rims are close to the tires, she's got a thick cushion, and even the caster wheels branching out from the footplate is a good call. On an adult chair, the footplate would be lower - but for a pediatric chair, the footplate is higher, which means this artist had a great attention to detail!
The low back is also great - Babs still has full use of her upper body, so she needs less support, and can benefit from having her shoulders/arms freed up for stronger pushes.
The Decoration
Yes!!! She is making that chair her own. Full spoke covers like that are more expensive than most, if not all other decorations, but they have practical and decorative benefits. So often wheelchairs that are depicted in comics have no decorations. I know very few people who don't like a little something on their chair to make it their own. This was a great call.
The Attitude
She can manage! This whole novel does a great job, in my opinion, at depicting internalized ableism and the medical model of disability.
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midwesternvibes · 1 year ago
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Time for more Seperated Leo Human AU! (I really need a name good lord-)
As promised, we now get to look into Leon's lore! He's a funky little guy, and shockingly well adjusted!
Lore drop under the cut!
His full name is Leonardo Tomás Esposito, and he is quite proud of it! He picked it out himself when he was about 10 years old, and he's happy to say that he still loves it to this day! (Fun fact: all of the names have double meanings to them hehe)
But anyways, his Mamà is in fact, NOT Big Mama (but it was a solid guess!), her name is actually Mia Esposito! (+10 Fandom points to anyone who can guess her full first name) She is a full time nurse and used to travel around the several NYC hospitals as an on-call nurse, but once Leon was born she stuck her roots down to one and has been there ever since!
She's actually an incredibly interesting character (with her very own arc!) with a lot of depth and meaning. She grew up with her Puerto Rican mother and Italian father, but after a series of misfortunes and despair, she ended up immigrating to NYC to start a new life for herself. About 10 years later she began raising a baby all on her own as a single immigrant mother in New York City (Sound familiar?). Whenever Leon asks about his father she tells him that she doesn't remember his Papá, only that he had the same almond-shaped brown eyes as her baby boy....
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But ultimately she doesn't remember him hahaha maybe Leon should stop asking questions and get back to studying!
(Leon knows that she's hiding something, but ultimately he doesn't care about his father that much, he just assumes that he did something to hurt his Mamá and wants nothing to do with the man at all)
Leon and his Mamá are very close, they're very similar to Percy and Sally Jackson from the PJO series, and they would definitely fight God for each other.
Leon was raised very much with the mentality of "It takes a village" and has many aunts and uncles and relatives in the hospital staff that he considers family. Mia couldn't really afford childcare as Leon grew up, as it often came down to food or rent for the month. The hospital staff saw this and absolutely adored little baby Esposito, so they were more than happy to raise him alongside their own children. Mia owes her life to this staff and considers them her family through and through.
As he grew up, Leon saw all his favorite people as nurses and doctors and considered each and every one of them heros. He decided very early on that he wanted to be a doctor when he grew up, and after a terrible injury when he was 14 it cemented the fact that he wanted to be a pediatric surgeon, to help kids just like him.
But the issue is, Leon and Mia definitely do not have enough to cover medical school for Leon on a single nurse's income, even with all the jobs that Mia and Leon have taken over the years. That's why Leon NEEDS the athletic and valedictorian scholarship, without it he won't be able to achieve his dream. The only thing standing in his way is.....
THE HAMATOS
(Except Michael, he's a gift)
Leon is willing to do ANYTHING to get those scholarships, but his Mamá always reminds him that the Hamatos might need it just as badly as he does, and that's about all that's keeping him from REALLY doing anything to hurt/sabotage them. His Mamá has instilled a really strict moral code into his psyche and he won't actually do anything to them, he just....really wants to give his Mamá a better life, one she deserves.
Although, he is kinda curious as to why the Hamato brothers have the same eyes as him......
First // Previous // Next
Whew! That was pretty much just a really intense ramble, sorry there was no actual structure to that, I just really wanted to talk about my Leon lore! Props to anyone who figures out the significance of all the names, and to clear up any confusion, Mia is Half Puerto Rican, half Italian, and Leon is 1/4 Puerto Rican, 1/4 Italian, and 1/2 Japanese (but shhh he doesn't know that yet) and obviously he's got that amazing vitiligo (shout out to anyone and everyone with vitiligo, y'all are amazing and beautiful)
Thanks for reading my lore dump, see ya next time for..... huh idk yet, vote ig
See ya next time!
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mariacallous · 8 months ago
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Paxton accuses Texas doctor of providing gender-affirming care in violation of state law
Texas Attorney General Ken Paxton (R) on Thursday sued a doctor in Dallas, accusing her of providing gender-affirming care to nearly two dozen minors in violation of the state’s law. 
Paxton accuses May Chi Lau of “blatantly violating Texas law” by providing hormone-replacement therapy to 21 minors in the period between last October and this August. 
His office said in a statement outlining the lawsuit that the doctor “allegedly used false diagnoses and billing codes to mask these unlawful prescriptions.” 
“Texas passed a law to protect children from these dangerous unscientific medical interventions that have irreversible and damaging effects,” Paxton said in a statement. “Doctors who continue to provide these harmful ‘gender transition’ drugs and treatments will be prosecuted to the full extent of the law.”
Texas’s Supreme Court upheld in an 8-1 ruling the state’s ban on gender-affirming care for minors in late June this year. 
Lau specializes in adolescent medicine. She is an associate professor in the department of pediatrics at the University of Texas Southwestern Medical Center. 
The lawsuit was filed in Collin County district court. 
The Hill has reached out to the University of Texas Southwestern Medical Center for comment.
State bans on gender-affirming care are set to come before the Supreme Court this session after the Biden administration challenged a similar measure passed in Tennessee.
“The laws are inflicting profound harms on transgender adolescents and their families by denying medical treatments that the affected adolescents, their parents, their doctors, and medical experts have all concluded are appropriate and necessary to treat a serious medical condition,” the Department of Justice wrote in court filings. 
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librarycards · 9 months ago
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asking this not as a gotcha, but genuinely for perspective, as i respect how much you've read and wrote about antipsychiatry. so, i was committed in a psych ward as a teen, and the help i received there inspired me to pursue becoming a pediatric psych np. there's a lot about the system that angered me, but the good nurses i met there had an impact on me. i've also had a rough time finding the right prescribers for meds as an adult, and i've considered working primarily in medication management- to be the attentive resource that i wish i had years ago. i see you've answered someone who aspired to be a therapist- but would my goal be more likely to hurt than help, in this system? i intend to be critical, and not spout shit like ODD as a legit diagnosis; rather, my main goal would be to recognize how a kid's home is affecting them, as having that safer space away from my own home helped me realize the context of why i was that way. but plenty of people claim to have the best intentions, and then become abusive once in these positions of power, so perspective would be very appreciated. thank you
hey anon - thanks for this message. i've answered similar ones a few times before (1) (2) (3), but here are a few thoughts:
honestly, most good/good-intentioned people don't last very long in highly abusive institutional environments. my current therapist started out in a residential ed treatment place, and left to start a private practice because she couldn't stomach the abuse she faced from her superiors, nor the abuse she was expected to inflict upon residents. i have disabled/Mad friends who have gone into social work and/or psych-focused medicine. i do not know of any who have stuck around in psych ward/other high-control settings. it's a painful, demoralizing job even for people without lived experience, never mind for those of us who have been through it as patients.
the ones that stay often harden. there are always exceptions - there were a couple of staff in each of the places i was that were truly special people, not because of the institution but in spite of it - but most of the staff i encountered, from psych nurses to house parents to psychiatrists to social workers - were sharp and cold. maybe you won't become this, but either way, you'll have to put up with it.
and that's the fundamental problem, imo. even if you preserve your own code of ethics, you will not only be structurally limited by the regulations and demands of wherever you work, but you will also be in an atmosphere at best apathetic and at worst actively hostile to the autonomy and well-being of patients as such. you will have to choose between standing by at times of injustice/violence, or risking your job. we both know what happens behind those locked doors.
at the same time: these units will not close if you choose not to work there. people will not stop needing medication management; kids will not stop needing support amid abusive family/home situations. at the same time, it is in practice extremely difficult to effect real change for kids experiencing abuse - hard to get kids out of abusive homes permanently, hard to find non-abusive foster families, impossible to effectively support traumatized young people in these times of transition given the piss poor systems we have.
whether you'd be "hurting more than helping," while a fair question, is beside the point. i'm not entirely sure it's possible for anyone within these institutional strictures to 'help' in a long term sense at all. BUT, you would certainly make peoples' lives/stays in the hospital less painful in the short-term, even if you're pulling your hair out with frustration at the intransigence and needless cruelty of your colleagues. while you're considering what to do in career terms, i think it's also worth considering leadership positions where you can be a safe, supportive adult for young people without the expectations of the institution - a scout leader, coach, theater director, etc. (these are also not mutually exclusive with actual careers ofc) if you wanted to focus on the medical space, patient advocacy is also an option.
overall, i don't want to uniformly tell you "don't ever go into that", because, as i said, the position will exist regardless and i would prefer Mad kids to have as much access to compassion as humanly possible in a profoundly cruel system. but i also want to make clear that the violence attendant to that system will not be escapable for you, nor will you be able to move through it without perpetuating some of your own. think carefully about what you're able to tolerate.
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By: Genspect
Published: May 15, 2025
In May 2025, Texas passed Senate Bill 1257 (SB 1257) with an 87-58 vote in the House. This law requires insurance providers covering sex-trait modification treatments, such as hormone therapy or surgeries, must also fund complications, reconstructions, and recovery care. Genspect has worked on this bill since 2022, and we believe it should inspire similar legislation across the nation and the world. Why is this significant? How will it reshape Texas and potentially influence other regions? Let us explore.
So called gender transition treatments and procedures—hormone therapy, surgeries, and related interventions—are often promoted as solutions for distress by organizations like WPATH, the American Academy of Pediatrics, and the Endocrine Society. However, recent findings, including the HHS report and the Cass Review, reveal weak evidence for the safety and efficacy of these treatments. President Trump’s Executive Orders on gender, which cut funding for institutions offering such procedures, will likely reduce their prevalence. Yet, as long as insurance providers and Medicaid cover these interventions, they will persist.
While insurance often funds medicalized sex trait alterations, it often excludes costs for addressing complications, reconstructions and on-going health monitoring. This gap is not merely a practical issue for tens of thousands of individuals; it conceals the crisis of iatrogenic harm caused by these procedures.
Proponents of sex-trait modification treatments have long dismissed detransition as a myth and claimed complications are rare. They sustain this narrative partly because the system operates like a conveyor belt: when initial interventions fail to deliver desired outcomes, further procedures are presented as solutions. For those seeking to reverse course, returning to the practitioner who initiated their path is often the last thing they want to do. Additionally, the medical system lacks diagnostic and billing codes for unique complications—like vaginal atrophy in a 25-year-old masculinized woman or fistulas in a surgically constructed anatomy—rendering these adverse effects invisible.
Senate Bill 1257 addresses this issue directly. It requires insurance providers covering such procedures to also fund care for complications or reconstruction and on-going health monitoring. Imagine undergoing surgery only to discover that insurance will not cover follow-up care if healing falters—that is a crushing burden. This bill prevents such scenarios, offering critical support for individuals who detransition, a group gaining increasing recognition. It ensures assistance is available, regardless of the path chosen.
How will this change the landscape? The legislation will likely encourage greater caution among physicians and insurers. Doctors may perform more rigorous evaluations before recommending medicalized sex alteration, ensuring patients understand the risks. Insurers may become more discerning about what they cover; however, they must continue to care for those who have already undergone these treatments. The bill will also reveal the true scope of post-medicalization complications, reducing cases of individuals facing unaffordable bills after procedures go wrong. Furthermore, it may foster more transparent discussions about the risks and benefits of these interventions, benefiting all involved.
What can we expect in Texas and beyond? In Texas, Senate Bill 1257 aligns with existing policies, such as Senate Bill 14 (2023), which restricts sex-trait modification treatments for minors. This new law extends some protection to adults, addressing a critical gap.
Could this approach spread? We hope so. Other regions, particularly those with similar healthcare perspectives, are observing Texas closely. If Senate Bill 1257 proves effective, other states may adopt comparable measures. Unfortunately, most insurance plans are regulated federally. To ensure protection for all citizens, similar policies must be adopted in Washington.
Ultimately, Senate Bill 1257 ensures individuals facing challenges are not abandoned. Though not flawless and likely to face opposition, it marks a vital step toward a healthcare system that supports people navigating gender distress.
==
If detransition is "rare," then there should be no opposition to this bill. Nobody is going to need it, right?
Some of these retards even tout that Rogaine, liposuction and haircuts are "gender affirming care." But somehow, a girl with a beard, no breasts and a baritone voice trying to detransition to look female again is not.
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covid-safer-hotties · 10 months ago
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University of Alberta researchers retract COVID study, citing multiple errors - Published Sept 6, 2024
Incidence of pediatric long COVID higher than had been reported in JAMA Pediatrics
A University of Alberta study on long COVID in children has been retracted.
The study found a "strikingly low" incidence of long COVID among children ages eight to 13 who contracted COVID-19.
However, during a review of their results, the authors discovered a key figure was incorrect.
The researchers had focused on a group of 271 children who tested positive for COVID and for whom there was sufficient data to determine the presence of long COVID.
Of that group of kids, only one — or 0.4 per cent — met the World Health Organization's definition of the condition, according to the study.
Incidence of long COVID 'strikingly low' in children, Alberta researchers find But after review, the authors found the actual incidence of long COVID in children and teens in the study group, is 1.4 per cent — or four out of 286 rather than one out of 271.
The authors of the article, published in JAMA Pediatrics, requested a retraction because they identified "methodological (analytical) errors" in their original report.
Dr. Piush Mandhane, a professor with the department of pediatrics at the University of Alberta, wrote a retraction note on behalf of his co-authors.
In the note, Mandhane explained that the errors impacted the researchers' estimate of prevalence of long COVID in children and adolescents and the "reported associations between pre- and post-COVID-19 symptoms."
"We identified a coding error whereby children with missing symptoms data were coded as having no symptoms. This error resulted in two participants being misclassified as having symptom resolution when they should have been classified as having [long COVID]," Mandhane wrote in the retraction note.
After the original study was published, the authors classified another child as having long COVID.
Other errors included the exclusion of 15 participants who should have been included in the study, and counting participants who fell outside the sample's age range of eight to 13 years old.
"We identified participants with COVID-19 [cases] who were recruited between one and 7.49 years and 14.5 and 19 years of age," Mandhane wrote in the retraction note.
There were other coding errors.
"We apologize to the readers and editors of JAMA Pediatrics for these errors," Mandhane wrote in the note.
"In discussion with the editors, who shared their concerns about the analyses and data reported, we are requesting a retraction of our research letter. All the authors of our research letter are in agreement with this retraction," Mandhane wrote.
JAMA Pediatrics is part of the JAMA Network, a group of medical scientific journals owned and published by the American Medical Association.
JAMA Pediatrics claims its impact factor is 24.7, which makes it the highest ranking pediatrics journal in the world.
JAMA Network declined to provide comment for this story.
"We believe the retraction letter from Dr. Mandhane speaks for itself," a public information officer for JAMA said in an email.
Dr. Kieran Quinn, a clinician-scientist at the Sinai Health System in Toronto, said in an interview that "it's important to acknowledge that research is a very difficult and sometimes messy endeavour."
"I commend the authors on their thoroughness in identifying these errors in their analysis and in transparently fixing them," Quinn said.
"In this case, they felt, along with the editors of the journal, that the errors were sufficient and numerous enough that they should actually retract the article rather than just correct it and update the analysis, which isn't always the case.
"I think that's actually an acknowledgement that they are good researchers and they're doing this in an ethical and responsible approach."
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cranquis · 11 months ago
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This might not be the right place to ask but I always appreciate your insight on this hellsite. I recently finished undergrad and have started doing research to hopefully gain some industry knowledge and eventually go to med school. I have worked in emergency medicine for many years and it has really inspired me to pursue medical school with being an EM physician as a tangible end goal. My problem is that now that I am doing research it feels like the ball is going to drop at any moment. Like in clinic I get anxious that my subject will code while we are talking or seeing the paramedics transporting patients raises my heart rate. I feel fine and calm most of the time but I just have this nagging fear that something terrible is going to happen to my subjects or the people around me. And I know that I have clinic RNs and my MD nearby and I know where the crash cart is but it is still stressing me out. I don’t know how to rationalize it as I have never had any real anxiety or fear surrounding my time in the ED.
I guess the root of this question is that you probably saw a lot of intense things during rotations/clerkships/residency that were in high stress environments like the ED, how do you manage that working in an urgent care where things are less life and death most of the time - obviously there are still critically sick/injured people who show up there instead of the ED and the ED is getting the 2a medication refill requests, but I think you know what I mean.
Sorry if this is rambly, I just haven’t been able to see my ED people in a while and I can’t really talk about this sort of thing with many people outside of them. Once again I appreciate the insight that you bring to these sort of unique to healthcare situations, it has made dealing with patients and a failing system more bearable over the years.
Hello my aspiring colleague! I think I understand and empathize with where you're coming from.
The more you learn about what can go WRONG with a human body, the more you expect it to go WRONG. Like, any moment now. And when you're surrounded by the sickest of the sick, that starts to seem the norm. You expect This Guy, being transported for subacute cough, to crump... because you've seen other Guys with subacute cough crump.
[Crump: verb; to suddenly decompensate clinically, usually right after you told the attending that the patient looks stable.]
In a similar fashion, when I did my pediatrics rotations in med school and residency, I felt like Mrs Cranquis and I should never ever have children, because "look at all these tragically sick unfortunate children! Look at how suddenly these healthy kids can have an accident or develop symptoms from a hidden congenital condition!" It took a few years to put it into statistical perspective and realize that the odds of having a healthy child are actually better than 50:50.
But regarding your increasing worries that someone will crump in your presence - thankfully, the more you learn about what can GO wrong, and the more times you SEE things go wrong, the more you are also learning about what YOU can do to FIGHT wrong. This helps you fine-tune your anxiety into a Spider-sense -- an ability to be aware that your patient might crump even before they crump, which gives you the time to mentally (and clinically) prep for the worst and take steps to prevent it, to marshal your resources and colleagues and even make a "crump preparedness plan".
In fact, with a few years of experience, you learn to be grateful for that sudden ball of stress in your gut, as your subconscious points out the subtle clues that This Guy needs your full attention.
So I hope this helps give you the oomph to keep on going, friend!
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12 years after the good ending of OMORI, Hero reflects on the unexpected turns his life has taken. He wasn't the same person he used to be and knew he would never be that person again. After such a devastating loss, he had truly believed he could never be happy again, but things were different now...
OR Hero finds healing and loves again (the abridged version).
Past Hero/Mari and Current Hero/Zoey (OC) Slice of Life, Romance, and Hurt/Comfort.
Rated G. Spoilers for OMORI and some discussion of canonical character death, grief and mourning.
Word Count: 4,950. Full Text Below the Cut. Link to the Work on AO3.
A/N: Both of us creators are passionate Hero/Mari shippers, but we are also huge believers that Hero deserves to be happy and that Mari would want him to be happy. He might not ever be ready to move on and might not ever want a romantic relationship like that again, but if he did, this story is just a little glimpse into what we hope it would be like. It's a delicate situation, and we hope this little story has done justice to his grief and the kinds of struggles he would experience in moving on while also realizing it doesn't mean he has to forget.
This story includes specific references to the other stories in the "When Sun Shines Again" series (particularly "Am I Ready For Love Or Maybe Just A Best Friend?"), but this should stand alone and work as a sort of abridged version and epilogue to everything else so reading the other stories is unnecessary. The cover is Mod Sprinkles' art with the title graphics free to use from Canva. Thanks for reading! ☂️
“I missed this, you know…”
With a flick of the spatula, Hero flipped the egg he was currently frying, but he smiled—turning to Zoey with warm, affectionate eyes. “Yeah, me too. It’s been too long. Sorry…” He sighed wearily as he stirred the sauce for his chilaquiles. “We used to have brunch all the time…”
His voice trailed as he thought of the pediatric PM&R residency that had been running him ragged for the past five years leaving barely any time for anything else. Gone were the days of making brunch every Sunday for his friends like he had back in college. Most days he couldn’t even find the time to make himself a sandwich.
Zoey chuckled as she tucked a piece of short red hair behind her ear. “I meant I missed you, Hero—not brunch.” As she leaned over the counter, her light, teasing laugh wrinkled her freckled nose. “I would have been perfectly happy picking something up from that bagel place down the street and just sitting here doing nothing. You didn’t have to cook for me on your only morning off this week.”
“I know, but I wanted to,” he insisted with a gentle smile as he met her green eyes. “I feel like I never see you anymore.”
“It’s okay. You’re a medical resident,” she replied in that matter-of-fact way of hers. “I don’t expect to see you.”
Hero sighed heavily. He supposed she had a point. Residency was…a lot. Truthfully, he felt like he didn’t see anybody anymore. Something guiltily coiled in his stomach as he thought about his missed calls from Kel or Sally’s dance recital he had had to skip out on. He had rescheduled on his parents about half-a-dozen times when they had wanted him to go through some boxes of his stuff they had found in their garage, and he had missed Sunny’s daughter’s first birthday when he just couldn’t get out of work.
Despite his best efforts to be present for his loved ones, he had to develop a code system to classify emergencies. These days it was nearly impossible to get ahold of him unless someone texted him “Tea Time” indicating they needed immediate assistance that just couldn’t wait.
It was Zoey’s idea, but she had never used it.  
If Hero was being honest, that made him feel particularly guilty. He couldn’t stand the fact that he felt spread so thin he didn’t have much left over to give her. She didn’t seem to mind though—usually shrugged it off with insistences that she was busy with her own career too, her dream job: building bridges as a civil engineer. Perhaps that was part of what worked for them. She was so independent—never needed what he couldn’t give her, but that didn’t mean he wanted that for her. He couldn’t help but feel she deserved so much better, so much more than what he had to offer…and not just in terms of his time and attention.
“You have to work again this afternoon, right?” asked Zoey pulling him out of his thoughts. When he nodded, she added, “Just don’t wear yourself out, okay?”
“I’ll try my best.”
As he turned to crack another egg, he caught sight of Zoey’s hard hat on the counter. “Do you have to work today too?”
She shrugged. “Technically no, but I said I’d swing by the building site.”
“In this weather?” Hero’s brow furrowed as he glanced out the window watching the violent pattering of the rain against the glass. “It’s really coming down out there.”
“It’s fine. I have an umbrella.” She waved her hand dismissively motioning to the corner where she had placed the familiar red umbrella she had let him borrow the night they officially met twelve years ago. It was hard to believe it had been that long. “Besides you know I don’t mind the rain,” she added with a smile. “And this helmet’s water resistant.”
“Nice hat,” Hero gently teased—the slightest twitch of a smile curling in the corners of his mouth as she playfully nestled the thick plastic rim into her short red hair.
“You really do love this hard hat, don’t you? You want to try it on or something?”
Hero laughed but shook his head. “I’m not sure it would look nearly as good on me.”
Zoey’s lips curved into a teasing smile. “Oh but everything looks good on you, Mr. Prince,” she quipped, and Hero couldn’t stifle his laugh at her use of the rather cheeky nickname she had given him back in their undergrad. He was honestly surprised it had stuck around this long—though these days she only used it when she was playfully teasing him. “Even those bright green scrubs. I’m going to miss them when you’re not a resident anymore, you know?”
Hero chuckled but sighed as he adjusted his shirt under his apron—medical resident green as Aubrey probably would have said. He had honestly forgotten he was wearing scrubs right now as he had been planning to change into different ones right before he left for the hospital, but they had been the only thing clean in his closet. He really needed to do laundry though he didn’t mind scrubs and definitely hadn’t minded the color. Still he conceded, “I think the lab coat will be better. Just a few more weeks of these. It’s honestly kind of hard to believe it’s almost over.”
Zoey chuckled then dryly teased, “What are you going to do with all that extra time?”
Hero tilted his head. “I have a few ideas…”
“Is one of them getting a good night’s sleep? Because I think you should bump that up to the top of the list.”
“Yeah…” he chuckled before giving the sauce another stir and flipping his eggs. That wasn’t exactly what he had in mind. Instead he felt a smile tugging at the corners of his mouth as he thought about his Mamá Alma’s engagement ring he had recently picked up from his safety deposit box at the bank. When his grandmother had given it to him years ago, he had honestly thought he would never use it, but despite his protests that he could never love again and her beautiful jewelry would waste away in a vault forever, she had just patted his cheek calling him ‘concinerito’ just like she used to do when he was a little boy and said, ‘El corazón hace espacio’—‘the heart makes room.’
For a very long time he hadn’t really believed that or at least, hadn’t really understood it, but, as unbelievable as it was, things were different now.
Zoey had been his best friend for over a decade, and he had loved her for years without realizing it or, rather, without being ready to accept it. Even though everyone they knew would have insisted it was a long time coming by the time he had finally asked her out for a cup of coffee three years ago, it still didn’t seem real. When Mari had died, Hero had genuinely believed he never would and never even could feel that way about anyone ever again, and truthfully, he had been planning to never really move on. But…there was just something about Zoey. To this day, he still couldn’t even begin to describe or explain the way he felt about her—the way she made him feel things he didn’t know he could feel anymore. The way her smile healed something in him. The way he could look into her eyes and see a future, a life he had never imagined was possible for him anymore. The way she made him believe he could be happy again—made him believe he could love again.
There was no one else in the world like her. She was brilliant, driven, and really spunky—a little rough around the edges but so empathetic, so much softer than she wanted people to know and an amazing friend. Back in college when he never would have imagined he would eventually date her, they used to stay up until all hours of the night making sandwiches and drinking tea whenever their fraternity and sorority hosted parties and they’d just talk for hours about anything, everything. She was so passionate, especially about bridges and her dreams of wanting to build them someday. Hero could have listened to her talk about it forever even though he didn’t know the first thing about engineering. Perhaps even more than that, she was easy to talk to too—had this way of seeing through him. It was vulnerable but safe. He found himself telling her things that he could never tell anyone else—things about himself, his life, his family, and his past: mistakes, regrets, fears, even his grief.
He’d never forget the first time he told her about Mari. It was the first time that he had ever told anyone who hadn’t known her about it, and he didn’t know what to expect, didn’t know what she would say. In his wildest dreams, he would have never imagined she would cry for him, hold him, tell him that she wished he had gotten to have his “forever” with her. He was so moved just thinking about it, and to this day, he could barely believe that someone could care that much, could love him that much after everything. It was more than he felt he deserved. And she deserved everything—deserved so much more than he had to give her.
He would give her anything, everything that he had to give—would do anything to make her happy, but he couldn’t help but worry it wasn’t enough. Even though he loved her in a way he had never believed he could love someone again, the truth was his heart was a lot more broken and bruised than it used to be. He was a lot more broken and bruised than he used to be. He just wasn’t the same person that he was before, but he desperately wished he could be that person for her, the kind of person she deserved—someone whole.  
“Hey, you okay?” she asked with a slight tilt of her head and a kind smile. Hero nodded.  
“Yeah, I’m okay. Just feeling a little sentimental, I guess.”
“Don’t tell me you’re going to miss all the insane hours and marathon shifts?” she teased, and Hero chuckled, somewhat grateful she didn’t quite know what he was getting sentimental about.
“No. I’m definitely looking forward to having a normal schedule for a change and consistent days off.” Or so he hoped anyway…but he didn’t add that part. Instead he turned off the stove’s burner and poured his salsa over the plates of tortillas, then topped with fried eggs before he handed one of the dishes to Zoey.
“This is delicious,” she said between forkfuls as he took a seat across from her at the table. “Though I expected nothing less from you.”
Hero’s mouth curved into a bright but almost bashful smile as he scratched the back of his neck. “I’m sure it’s not that great. I’m kind of out of practice…”
Shaking her head, she rolled her eyes at him somewhat affectionately. “I can’t imagine what ‘in practice’ would taste like,” she quipped before she took another bite with a satisfied hum. “Do you ever think you could’ve been a chef in another life?”
Hero chuckled lightly, but he shrugged as the slightest smile twitched in the corners of his mouth. “I wanted to be—back when I was a kid…” He paused, sighed. He knew she already knew that—already knew everything about him, but she didn’t seem to mind him repeating himself. He could feel her hand reach across the table to gently cover his until their fingers intertwined, until he looked up at her and met her bright green eyes—inquisitive but kind…and knowing as if she could see right through him and understood the bittersweet weight behind those words. As she tucked a loose strand of hair behind her ear, he squeezed her hand and added, “But I don’t want that anymore...”
“Think you’d be even more stressed as a chef?”
“Probably.” His lips twitched before he took a bite of his chilaquiles. “And you’d see even less of me.”  
Hero couldn’t help but smile at the way she stifled a laugh as she caught his dry joke. Zoey tilted her head at him. “What do you want now?” she asked, as if she didn’t already know the answer.   
His cheeks grew warm as he thought of that ring again, but he dryly quipped, “A good night’s sleep.”
She laughed aloud this time—her smile reaching her green eyes until she bantered, “Well don’t set the bar too high. Gotta keep those wildest dreams in perspective, you know? Make them attainable.” Despite the dryness of her delivery, she couldn’t quite hold back her smile. As Hero laughed, her expression softened. “You really do deserve some rest, Mr. Prince. Just because you can function on three hours of sleep, doesn’t mean you should. It shouldn’t be a dream—it’s pretty fixable.”
“You’re starting to sound like Kel…”
Zoey shrugged. “I’ve always said Scotty’s got a lot on the ball,” she said using the nickname she had given Kel over a decade ago on account of his penchant for fixing things. “It’s good advice, and I’m not just saying that because he agrees with me.” The tines of her fork scraped against her plate as she finished the last bite. She stared at her empty plate with a thoughtful hum. “Maybe I should head out—give you some time to take a nap before you have to work this afternoon.”
“You don’t have to stay, but I don’t think I’m going to sleep if you go so…don’t leave because of that.”
Zoey smiled but sighed. “Wishful thinking on my part, I guess.
A loud crash of thunder clanged outside the window, and she frowned. “I had better get going though—head over to the site before the weather gets any worse.”
With a brisk nod, Hero rose from his seat to help Zoey clear her dishes. “I’ve got it,” he insisted, but she somewhat playfully wrestled her plate away from him with a pointed frown.
“You cooked. I can clean up.”
As she quirked an eyebrow at him and crossed her arms, Hero sighed. He knew this look. It meant there was no point in arguing with her—not that he was much of an arguer to begin with. Still, he gently insisted, “At least let me help. It’ll be faster with both of us.”
Zoey teasingly rolled her eyes, but she shrugged. “If you insist…”
Hero nodded, grabbing his used pans and utensils and joining her at the sink. It was a little like déjà vu to be honest given how often they had done dishes together back in college—though Hero would be the first to admit it was much faster and much easier with a consistently functioning dishwasher.
As if she could somehow read his mind, she quipped, “Well this is familiar…” as she rinsed off their plates in foamy, soapy water. Chuckling, he gently nudged her with his shoulder as reached for a sponge to start scrubbing the remnants of fried eggs off his pan, and she let out a breathy laugh. “Can’t say I missed dishes too much—though they were always more fun with you.”
“Pretty sure that was you actually…” His mouth twitched into a kind smile. “You always thought of great things for us to talk about to help us pass the time.”
He could feel Zoey shift beside him, and she sighed as she intently scrubbed at the stained rim of the saucepan. “You know, there actually was something I wanted to talk to you about today…”
Hero hummed glancing at her over his shoulder as he loaded the silverware into dishwasher. “Oh?”
“Yeah, I wanted to ask you something…But you have to promise me you’re going to be honest.”
“Of course,” chuckled Hero, but Zoey didn’t laugh.
“I mean it. Don’t just say it’s fine because you think that’s what I want to hear.” She paused, and Hero could feel his face flush. “I don’t want to cross a line.”
His brow furrowing, Hero stopped loading the dishes and turned to look at her—meeting her eyes. “Zoey…” His voice hitched, and he could feel his hands trembling even as he tried to calm his breathing. “Is everything okay?”
She nodded with a slight, reassuring smile. “Yeah. Everything’s okay. I just…” Her voice trailed. She wouldn’t look up from the saucepan she was cleaning. “Do you think I could visit Mari’s grave sometime…?”
Hero froze. Of all the things she could have said, he would have never expected that. She had visited there with him several times in the past, but it was always as support for him when he was going there anyway. She had never asked to make a special trip before. It surprised him, but it didn’t necessarily feel like a bad thing.  “Uh…yeah. Sure,” he stumbled running a hand through his hair. “I um…Gosh, I don’t know when I’m going to have another day off but when I finally finish up this residency and get a more consistent schedule I’m sure we can…”
“Hero,” she cut him off. “I meant, could I go alone? Would that be weird for you if I went to visit her sometime by myself?”
Something twisted in Hero’s chest. He didn’t know how to feel—didn’t really know what to say to that. It seemed so unexpected, but he didn’t think he had a problem with it. After all, Zoey knew a lot about Mari—not just from him but from Sunny and Kel too, even Aubrey and Basil. He supposed it could make sense that she might want to visit her…but the truth was, he really couldn’t understand why.
Unless…
He swallowed hard—biting down on his lip. He couldn’t even think it.
“Hero?” He felt her hand on his shoulder, but he shrugged it off. “Just forget it okay? It was a silly idea. There were just some things that I wanted to say to her, that’s all, but if it’s weird for you, I don’t want to cross that line.”
“No. No, it’s okay. It’s not weird for me, if that’s what you want to do. It’s just…” His voice trailed. He didn’t have the words for what he wanted to say, the question he wanted to ask. In a way, he was almost scared of it—scared of the answer. The truth.
He had tried to avoid it all this time. While he had told her a lot about Mari, he had tried so hard to keep it focused on him and his grief—on how he felt when she died, how he had blamed himself, how it had wreaked havoc on his relationships with the people he had cared about most, how it nearly destroyed him and how he had never thought he could ever be happy again. But she popped up in his stories sometimes and he had told Zoey the most basic things about her that she was kind, smart, and talented, she played piano and was cheerful and warm, the kind of person you could always count on to be on your side or to brighten your day oftentimes just by smiling because when she smiled you would’ve sworn the sun shined brighter.
Zoey knew that he loved Mari, that a part of him would probably always love her. It didn’t seem to bother her at all, but it had been so hard for him to make peace with that in himself. Even now, there were times when he second-guessed himself, felt guilty that his heart was so broken and bruised—that he couldn’t give her everything that he felt she deserved. He desperately wrestled with the fear he wasn’t enough, with the feeling that it wasn’t fair to her that despite how much he loved her and would have done anything for her it would be impossible for him to ever say that she had been the one and only love of his life. He was terrified that she would feel slighted—that she’d compare herself to Mari and feel trapped in her shadow, feel like she was only a second choice or a last resort.
His heart ached when he thought about it—thought about how he could never be the kind of person that Zoey truly deserved: the person he had once been, in that other life before Mari’s death, but that person had died with her and no amount of healing could ever bring him back. There was so little he had to give anymore though he would give Zoey the world if he could. It was so hard to believe his painfully pieced together heart was worth much of anything—even though he loved her with every inch, every crack, every crevice, ever bruise and broken edge of it. He loved her more than he had ever imagined he would or even could love someone again. It wasn’t better or worse or more or less, just so different from the way he had loved Mari. He just wasn’t sure that was enough.
And now…he didn’t know if she was sure either. What else could she possibly want to say to Mari without him there than that she was just playing second fiddle, just taking her leftovers, just standing in as a last resort.
 “Zoey, I…” Hero’s eyes burned as the words got caught in the back of his throat, but he eventually choked out a rambling, probably incoherent, “You know I never wanted you to feel like you had to compare yourself to Mari. I…If I’ve ever done anything to make you feel like…like you—like you’re…like you’re only a—”
“Stop.” She cut him off firm but kind. Hero bit his lip, but he wouldn’t look at her. He couldn’t. “Look at me,” she said, but when he couldn’t bring himself to, her thumb traced gentle circles across his cheek. “Henry.”
He inhaled sharply, and something fluttered in his chest at the sound of his real name. She rarely ever used it—only when she wanted to remind him to stop being a “hero” and take care of himself or, he supposed, in times like these when she really wanted to get his attention. It had a weight and a gravity which was only intensified the minute he finally looked into her eyes and she said, “You have never made me feel like a second choice.”
He finally let go of the breath he was holding. In relief, his eyes fluttered closed, but he bit his lip. “I’m sorry…”
“There’s nothing to be sorry about,” she insisted. “You know how I feel. We’ve talked about this.”
They had. Multiple times. But that didn’t ever take away the nagging feeling in the back of his mind that “You shouldn’t have to…”
Swallowing hard, he took a shaky breath and turned away from her. His shoulders twitched as he stared down at his hands with a bittersweet smile. “I just…I want more for you.”
“More than the perfect man? I’d really like to see that…” she quipped dryly. “And I’m flattered, but I don’t think that’s possible, Mr. Prince.”
His mouth curved into a smile in spite of himself, but he could feel his face growing warm. “I’m far from perfect…” he sheepishly insisted, rubbing his hand across the nape of his neck. “And…” His smile faded. “I’m serious, Zoey.”
“So am I.” Her voice was matter-of-fact—honest, but an affectionate smile curved in the corners of her mouth. “There is no one else like you. You know I still field calls from my old sorority sisters asking how I managed to bag prince charming.”
As Zoey teasingly rolled her eyes with a shake of her head, an awkward, disbelieving chuckle escaped Hero’s mouth. He buried his blushing face in his hands as Zoey continued, “Of course, I never dignify that with a response, but…” She shrugged. “If I did, the answer is really, ‘I have no idea.’”
Hero laughed in spite of himself, feeling very guilty for it, but Zoey didn’t seem to mind—just chuckled lightly herself and smiled at him until her expression and her voice softened. “Jokes aside though I…I honestly didn’t think it was ever going to happen. Not that it couldn’t—just that…I didn’t think you were ever going to be ready.”
He nodded. The truth was he hadn’t either.
“No one would’ve blamed you if you weren’t. I definitely wouldn’t have…Moving on—being ready for that…that’s all you. That’s your choice.” She paused and met his eyes. “And you chose that—you chose me. And that means more to me than the idea of us being cosmically destined soulmates or the one and only love of your life. I don’t need that. I don’t even want it, and I don’t want someone who can give that to me. I only…want to be with you.” Shaking her head, she laughed at herself muttering, “That’s so corny…”  
Hero reached out his hand to her—pushing that one wild strand of hair out her face and pressing his palm to her cheek. “Mi vida…”
As she glanced up at him, he could only hope that the look in his eyes conveyed the deeper meaning of those words—conveyed everything he wanted to say every time he called her that. He didn’t use it often—didn’t really use terms of endearment much anymore. It felt wrong to call her the same things he had called Mari. He never called her ‘honey’ or ‘sweetheart’ or his most precious name for Mari, ‘Mi corazón’: ‘my heart.’ But Zoey and only Zoey was ‘Mi vida’—‘My life.’ She liked it well enough—thought it was a pun because of her name. Zoey. Life. His life. A life he never dreamed he’d be able to have.
“I love you,” he said, and her bright green eyes smiled at him.
“I know you do. And you don’t have to try to prove it to me by pretending Mari never existed.” She broke away from his gaze and glanced over his shoulder at the cluster of old photographs of him and his friends hanging on his living room wall—memories of that other life and who he had used to be back when Mari was alive. It had been Zoey’s idea to hang them up, and she said now exactly what she had said then, “Moving on doesn’t mean having to forget, Hero.”
His heart ached at those words, and he wrapped his arms around her and pulled her against his chest. He wasn’t sure how long he held her until she sighed, “I’m sorry. I shouldn’t have asked. I didn’t mean to upset you. I won’t go.”
“No, I think you should,” Hero insisted. “I mean…if that’s something you want or need to do.”
“It is. But not for the reasons you think…” She sighed. “Not because I’m comparing myself to her or anything like that. I guess I just…I wanted to reassure her that I’d take care of you. That’s all.” She pulled away from him with a soft, affectionate, smile. “Is that okay?”
“Yeah. Yeah, that’s…really good.” His eyes grew misty, and his voice hitched. “Thank you.”
Her smile brightened, and it reached her eyes. He knew that she understood those words meant infinitely more than what he had said.
“Hero…” she began. “You know I love you, right?”
He nodded, but he couldn’t hold back the smile that tugged at his lips. “Yeah.”
“Can I ask you one more thing?” she asked with a slight shrug of her shoulders.
“Anything.”
She tilted her head, pursing her lips together. “And you promise you won’t take it the wrong way?”
He swallowed hard—his hands beginning to shake again, but he managed, “I promise.”
Zoey took a deep breath—long and heavy. She stared at the picture of Hero and his friends in Faraway Park back before Mari had passed away—back before they were jaded, broken, before they had to learn how to be happy again. “Do you think she’d be happy for us?”
Hero’s chest ached, but a bittersweet smile tugged at the corners of his mouth. He thought about the last time he had visited Mari. He had gone alone—stopped there after he had picked up his grandma’s engagement ring from the bank. He had wanted to know the same thing. It felt strange to look for that reassurance—to look for some kind of sign when he knew Mari couldn’t really answer him. But Mari had found a way. When he had told her about his plans—asked if she would be okay with that, there was strong gust of wind. It blew a twig off a nearby tree that hit him in the head. He had laughed. As if Mari was trying to tell him what a silly question that was—especially when he already knew the answer.
He hugged Zoey again—glancing off over her shoulder out the window where the sun was peeking through the clouds even despite the rain. As a certain warmth spread through his chest, he blinked the mist out of his eyes and whispered, “I know she would be.”
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justinspoliticalcorner · 1 year ago
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Erin Reed at Erin In The Morning:
Over the past few weeks, Dr. Hillary Cass has begun giving interviews in the United States to defend her report targeting transgender care. The Cass Review has faced criticism for its alleged anti-trans political ties, biased findings, promotion of conversion therapists, and poor treatment of evidence regarding transgender care. In an interview with NPR, Dr. Cass claimed that transgender individuals' care should be judged by their "employment," rather than their satisfaction with the care received. Later, during an interview with The New York Times, Cass misleadingly stated that she had not been contacted by any lawmakers or U.S. health bodies, despite having met with political appointees of Gov. Ron DeSantis to discuss banning trans care before her report was published. In response, both the American Academy of Pediatrics and the Endocrine Society have categorically rejected the review as a justification for bans on care and have challenged many of its alleged findings. In a statement released by the Endocrine Society, they reiterated that they stand by their guidelines around the provision of gender affirming care for transgender youth: “We stand firm in our support of gender-affirming care. Transgender and gender-diverse people deserve access to needed and often life-saving medical care. NHS England’s recent report, the Cass Review, does not contain any new research that would contradict the recommendations made in our Clinical Practice Guideline on gender-affirming care… Medical evidence, not politics, should inform treatment decisions.”
[...]
Similar sentiments were shared by Dr. Ben Hoffman, president of the American Academy of Pediatrics, who responded to the Cass Review, “What we’re seeing more and more is that the politically infused public discourse is getting this wrong and it’s impacting the way that doctors care for their patients. Physicians must be able to practice medicine that is informed by their medical education, training, experience, and the available evidence, freely and without the threat of punishment. Instead, state legislatures have passed bills to ban and restrict gender-affirming care, which means that right now, for far too many families, their zip code determines their ability to seek the health care they need. Politicians have inserted themselves into the exam room, and this is dangerous for both physicians and for families.”
Transgender care saves lives. A Cornell review of more than 51 studies determined that trans care significantly improves the mental health of transgender people. One major study even noted a 73% lower suicidality among trans youth who began care. In a recent article published in the Journal of Adolescent Health in April of 2024, puberty blockers were found to significantly reduce depression and anxiety. In Germany, a recent review by over 27 medical organizations has judged that “not providing treatment can do harm” to transgender youth. The evidence around transgender care led to a historic policy resolution condemning bans on gender affirming care by the American Psychological Association, the largest psychological association in the world, which was voted on by representatives of its 157,000 members.
Interestingly, Cass herself advocated against care bans in her most recent New York Times interview released today, where she stated, “There are young people who absolutely benefit from a medical pathway, and we need to make sure that those young people have access,” although she added a caveat that those young people should be forced to consent to research in order to access care, leaving many to question the ethics of such an approach. Regardless of Cass’s statements, her review is being used to justify bans in the United States and worldwide. 
Both the Endocrine Society and the American Academy of Pediatrics came out to reject bans on gender-affirming care in the wake of the anti-trans Cass Review by Dr. Hilary Cass.
Dr. Cass herself advocated against bans on gender-affirming care in a recent New York Times interview; however, her report is being used as justification for bans on gender-affirming care worldwide.
See Also:
LGBTQ Nation: Cass Review author says leading medical org only supports trans health care under “political duress”
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