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Abbot’s got a look in his eyes at the start of the shift, like he’s 100% done with any and all drama - Trinity can’t blame him, it took Facilities hours to clean up the aftermath of an unfortunate meeting of a patient’s wife, mistress, and work fuckbuddy last night. So she’s not surprised when a few hours in, he sends her to check out a behavioural case with Langdon.
They’re both charting in the hub when they hear the guy being brought in, screaming and shouting at the top of his lungs while a woman accompanied by two cops trails behind the EMTs pushing the gurney, looking terrified and lost. Abbot waves the EMTs over to the Behavioural Health rooms and Bridget is already dispatching Princess and Mateo to assist, so Trinity ignores it all, assuming Abbot’s going to take it himself, until he snaps his fingers under her nose.
“Santos, you’re with Langdon on the screamer in Behavioural One, so finish up and get going.”
She can see Langdon’s head shoot up out of the corner of her eye.
“Dr. Abbot, I’m not sure Santos would be, uh, super comfortable with-”
In the reflection of the monitor Abbot’s already shaking his head. Damn. Trinity likes that he’s a hardass most of the time - he demands a lot from his students but it always feels like it’s in the service of their education, and he doesn’t hesitate to give praise when he think’s it’s been earned. But even on a good day his tolerance for interpersonal issues is low, and she remembers the look in his eyes at shift change. She’s not getting out of this.
“Dr. Santos needs to learn to work with whoever she is assigned to, and you apparently need a refresher, Dr. Langdon, unless whatever it is between you requires the intervention of HR?”
When Trinity looks away from her screen Abbot is stood between her and Langdon, eyebrows raised, arms crossed. He’s not actually tapping his foot but it feels like he should be. He knows damn well that she and Langdon had a series of excruciating meetings mediated by HR when he first came back to work, where neither of them could make eye contact while a very earnest HR lady had made upbeat comments about discussing their feelings in a safe space. Both of them had signed the forms agreeing that the hospital had fulfilled their duty of care and could not be held liable for any further personal issues as quickly as physically possible before completely ignoring each other any time they were on shift together. It was a good system, and worked brilliantly, until Abbot decided to fuck with it.
“It’ll be fine,” Trinity manages to force out, trying not to grit her teeth because her siblings have always told her it makes her look like she’s thinking about murder. “We’ll manage.”
Langdon is staring at her, so she probably wasn’t very successful at looking not-murder-y.
Abbot claps her on the back.
“Great. Langdon, go help the nurses get set up for sedation, Santos, quick word.”
Langdon shuffles off with speed. Trinity is cheering him silently. Maybe if the patient is knocked out quickly she won’t actually have to talk to Langdon at all.
Abbot leans over and mutters in her ear.
“I know about your history but I meant it - you’re always going to work with people you have issues with. This is the best practice you’re ever going to get at dealing with it.”
He straightens up, walks away, shouts back over his shoulder.
“Go get em kid!”
She knows he’s a widowed, disabled, tragic war hero, but he’s such an asshole. Trinity has no idea why so many of the nurses want to fuck him, other than her baseline assumption that straight women have terrible taste.
Langdon has sedated the guy by the time she gets to the room, but he’s still chatting with the EMTs and the cops. Mateo is securing the soft restraints, keeping one eye on the vitals, and Princess is holding the woman’s hand and patting her on the shoulder.
Langdon sees her coming and stops the EMTs mid-sentence.
“Alright then, full handover now that Dr. Santos has joined us?”
Trinity resists the urge to scowl because she’s an adult who can control her fucking emotions.
“George Melvin, 46 year old male, attempted suicide following acute onset psychosis. Wife says he’s been having trouble for a while, no obvious cause, but tonight he lost it and started yelling at her, and then tried to slit his wrists. She grabbed the knife, locked him in a bathroom, called us and the cops - he seemed to calm down and agreed to come with us, but he started going nuts again in the ambulance.”
The EMT, who she thinks is called Tarik but always refers to in her head as Terrible Goatee - she really needs to get better at names - glances at the police.
“If you guys are happy for the cops to leave - I really don’t think this guy needs police, it seems pretty straightforward depression and psychosis to us. We just kept them with us in case he got loose in the wagon.”
Langdon agrees, dismisses the officers with a handshake and a smile. If anyone notices the smile is a little tight they don’t say anything - Trinity knows how close he came to jail time, so she guesses it’s in his best interests to be nice to them, but it still makes her skin crawl a little.
Langdon finally turns to her. His dumb face has a little wrinkle in the forehead.
“So you wanna take the history from the wife, and we’ll go from there? Sounds like it’s going to be a pretty straight shot from here to a psych ward but he might be parked for a while, they never have enough beds, so we need the full history for monitoring-”
Trinity feels her annoyance spike.
“I’m not a first year med student, dude. I’m an R2 now, I passed my Step 3, I know how to take a history. Back off.”
Langdon takes a deep breath like he’s about to chew her out, but just lets it go in one loud exhale.
“Fine. You take the lead.”
He sticks his head around the door.
“Mrs Melvin, could we have a word? Mateo, if you could just keep an eye on Mr Melvin, and Princess, if you could go and grab Mrs Melvin some water?”
Princess ushers the wife out of the room. She seems shell-shocked. She’s small, mousy, fragile looking, with big dark circles under her eyes, wringing her hands together with obvious anxiety. Trinity tries to make her voice calm, authoritative but not harsh. She knows her bedside manner is crap but she’s working on it.
“Mrs Melvin-”
“Oh please, call me Hayley. Every time someone calls me Mrs Melvin I start looking around for George’s mother, and she’s an awful old cow.”
Princess nearly drops the water bottle she’s brought back. Trinity manages not to smile but it’s a close thing. Humour in this situation suggests there’s some steel at Hayley’s core and she doesn’t want to make her hostile.
“Okay, Hayley. Could you tell us a bit about your husband’s medical history, about what’s brought you here tonight?”
“I don’t know what to say, really. He’s always been healthy, never been to hospital except when he broke his foot when another bus drove over it - he works for the city, as a bus driver. He’s always been happy, really enjoys his work, but lately it’s like he’s been getting angrier and angrier, all the time. He nearly got suspended last week for shouting at a passenger - he only kept his job because his supervisor has known him for 20 years and she knows it’s not like him at all. He probably needs to lose weight and do more exercise but doesn’t everyone? I just can’t work out why he’s changed so much so quickly.”
“So his mood changes, that’s all recent?”
“A few months? It was like he woke up one morning in a bad mood and never got out of it. Sometimes he stops being angry but then he’s just… lost. Sad.”
“And there was no incident that seemed to set it off? No particular bad days at work, stress at home, a loss in the family? He hasn’t hit his head, or been having trouble sleeping?”
Hayley Melvin is shaking her head, looking increasingly close to tears. Shit. Trinity is really bad with weepers.
“Nothing! It really was just… one morning he woke up different. I remember it because he was supposed to take our daughter to an early soccer practice but he overslept so I took her, and when I got back he was furious at me because I hadn’t woken him up, and mad at himself for not waking up.”
The poor woman starts crying in earnest. Trinity can feel her face doing something horrified against her will and Princess swoops in to wrap an arm around her shoulder and guide her to sit on one of the chairs by the wall.
Langdon jerks his head over to the hub, so Trinity follows him to get some distance from the crying relative.
“So, Dr. Santos, thoughts?”
“Blood work up, check for drugs and toxins, infection markers, any metabolic abnormalities, hormonal issues, and a CT to rule out neurological involvement.”
“And if all of that is negative?”
She shrugs.
“Refer to psych and monitor with sedation until they can take him.”
Langdon nods, and gestures to the computers.
“Go ahead, Dr. Santos, and come find me when the results come back. I’ll go and tell the wife.”
Trinity escapes to order the CT and draw some bloods with a sense of profound relief.
The next part of her shift goes pretty smoothly. She gets to hold a tiny baby with a mild fever whose mom needs reassurance that the baby really will be okay with some infant Tylenol, and tries not to let on how happy the baby’s gummy smile makes her. She sews up the forehead of a teenager who was kicked in the head when she tripped over her own shoelaces during a soccer game, assesses multiple elderly patients for fractures after falls, and helps Ellis and Jesse with a complicated posterior shoulder dislocation that needs all 3 of them to reduce it while the patient sucks desperately on Entonox.
The audible pop as it finally jumps back into place is extremely cool.
Then there’s an MVA, car versus motorbike, and while other residents are assessing the car driver and passengers Abbot takes her into Trauma One with the biker, who has the craziest flail chest she’s ever seen. He teaches her to place a double lumen endotracheal tube so that mechanical ventilation won’t cause his broken ribs to puncture his lungs, and even talks her through the right settings to use on the ventilators. Garcia watches the whole time and even tells her she did a good job before she takes the guy up to surgery. Trinity kind of wants to skip out of the room and punch the air. Being a surgeon would have been awesome - but emergency medicine is the adrenaline rush that never stops giving, and she doesn’t regret staying.
Abbot’s mood has apparently recovered enough that he doesn’t tell her off for being pumped, just grins at her and tells her to go and check on her other patients. Trinity knows him and Robby are constantly having existential crises about all the people they can’t save, but unlike Robby, he gets the rush when he saves someone against the odds. Everyone in the ER seems to be clinically depressed or an adrenaline junkie, and she’d rather be up than down.
Speaking of junkies, her mood falls when she checks and sees the results for Mr Melvin are in. Ugh. Langdon.
His face definitely falls when he sees her coming over with the tablet. Good to know the feeling is mutual.
“All of Mr Melvin’s tests were normal.”
Langdon sighs.
“Okay, so refer to psych and let Bridget know we might have a camper in Behavioural Health until they find a bed.”
Trinity nods, but something is bothering her.
It’s been bothering her since she picked up the results and maybe even earlier, since she talked to Hayley Melvin.
“Doesn’t it seem weird to you?”
Langdon had already been turning away. He rotates back round on one foot, frowning.
“In what way?”
Trinity shrugs.
“It’s nothing specific, it’s just - he literally woke up one morning in a bad mood and his mental status declined from there. That doesn’t seem off to you? It doesn’t seem like a typical profile for depression or psychosis, to suddenly go from nothing to something with no outside pressure.”
“He missed his daughter’s soccer practice. Doesn’t have to be a big deal to set someone off, could cause some kind of spiral of self-loathing, not being there for his family-”
Langdon breaks off, suddenly looking haunted. Right, he’s getting divorced and he’s in a custody battle. Trinity refuses to feel sorry for him, because she’s too busy trying to make her point.
“I know that, I know that depression and psychosis can be primary diagnoses without underlying causes, it just… doesn’t feel like that.”
Langdon doesn’t say anything for a second, just watches her. She refuses to flinch or squirm or look away, because she’s doing nothing wrong. Has done nothing wrong.
She’s prepared to fight him on this, but finally he nods at her.
“Okay, you have a hunch, but what are you going to do about it? His CT and bloods were clean, you literally just told me that.”
Trinity resists the urge to bristle like a porcupine.
“MRI. It’s more sensitive than a CT if there’s a small issue. And I want a radiology attending to look at it, not a resident.”
Langdon nods again.
“I’ll sign off on it. Cremini isn’t on call tonight, but he can look at it from home, and he’s got a special interest in neurology imaging. He owes Abbot about 5000 favours, so go ask him to call it in - I’ll back you up if you need it but Abbot likes you so it shouldn’t be an issue. Come get me when Cremini gives you the results, okay?”
Langdon wanders off down to Chairs, and Trinity is left blinking. What the fuck. Is he actually supporting her on her crazy hunch? Doesn’t he hate her?
She shakes it off. Patient, Abbot, MRI. Shit to do.
Abbot does his raised eyebrows, are-you-sure face at her, but he does call the radiologist.
She asks MRI to send the results to Cremini rather than the duty resident, which they complain about, because radiology hates the ER for making them work nights, but she gives zero shits and they give in eventually.
It’s almost an hour before Cremini calls back. Abbot makes him wait for Trinity to get Langdon and they crowd around his iPhone on speaker in the stairwell.
“JACK, YOU ASSHOLE.”
Trinity jumps a bit but Abbot and Langdon just look resigned so she guesses this guy always roars at maximum volume.
“I WAS OUT WITH MY WIFE, AND YOU KNOW HOW SHE FEELS ABOUT HOSPITAL BUSINESS ON DATE NIGHT.”
Abbot snorts out a laugh.
“Gary, I will absolutely stop sending you extra work the day I stop telling your wife you’re here when you’re actually golfing. Tell us about the MRI.”
There’s some kind of complicated breath noises on the phone that could be outrage or could be respiratory difficulties. Nobody else seems alarmed so Trinity figures it’s the former.
“I nearly missed it, you know. We don’t normally pick this up until post-mortem, so you’re damn lucky I hadn’t finished my first glass of wine. If you look at where I circled on the photo-”
The phone pings with a message and they all squeeze their heads in to look closer.
“-small lacunar infarct. Old now, can’t tell how long it’s been there but definitely could have been causing cognitive problems. Wouldn’t have been any obvious motor or sensory issues to alert the patient or family, but the damage was already done. Poor bastard.”
Abbot claps her on the back and takes his phone off speaker, turns away to start ribbing the guy about golf. Langdon makes for the door back into the ER and Trinity scrambles after him, trying to make sense of the diagnosis.
“Lacunar infarct - he had a stroke?”
Langdon nods.
“Yeah, smallest kind.”
She’s struggling to understand.
“And nobody noticed?”
“Silent stroke. Most people will have visible symptoms, or none at all, but he had one that affected him cognitively but not physically. Probably when he was asleep, maybe the day of the missed soccer practice. Clot gets loose in the blood vessels, blocks a cerebral artery, kills a tiny part of his brain. It leaves him unable to think straight when he wakes up, so he gets frustrated, angry, depressed, and eventually develops psychosis. You want to tell the wife?”
Trinity stops almost mid-stride, realising they’re almost at Behavioural Health.
“What do I tell her? Her husband has a fucking hole in his brain and nobody noticed? What do you even offer for that?”
Langdon looks at her. He’s frowning again.
“Santos, calm down. Think. You told me you’re a real doctor now, right? So you tell me, what is your recommended course of treatment?”
Trinity rubs her eyes. She really hates that he’s being a teacher right now, especially that he’s being a good one, just enough of an asshole to get her to respond, but not so harsh she’ll retreat. She hates him so much.
“Uh, now that there’s an underlying condition… Admit to psych still, for the acute psychosis. But he’ll need a referral to neurology for a full assessment, and then probably neurological rehabilitation. And another referral for counselling, and probably for the wife too.”
Langdon looks - not pleased, but satisfied.
“Okay. You want me to come with you? In case she has questions you’re not sure about?”
Trinity hates her answer before she’s even said it, but - he may still be a resident but he’s on his second time doing his final year. He does, actually, have more experience than her, and talking to relatives is one of her weak points.
“Yes. Please.”
Talking to Hayley Melvin is just as awful as she thought it was going to be. She cries, a lot. She tells herself off for not noticing that her husband had a stroke. She remembers she has to tell her kids and starts sobbing in a really alarming way.
Luckily Langdon had grabbed the on-duty social worker before they started the conversation, so after Trinity has stumbled over explaining the treatment pathway she gets to leave Hayley weeping on Joel, who is taking getting covered in the snot and tears of a random middle-aged white woman with a hell of a lot more professional dignity than Trinity would be able to manage.
Langdon walks off towards the board like - that’s it, like he hasn’t been a helpful, useful presence on this case despite the fact that she fucked up his entire life.
Something inside her snaps.
“What the hell.”
Langdon turns around very slowly, like he’s what, afraid of her?
She gesticulates.
“What was that? You just fucking - believed me? I had no evidence at all of that guy being anything other than a psych patient, but you told me to go and get an MRI! You told me to get Abbot to call in a favour! You said you would back me up! What the fuck man, you fucking hate me, why are you being nice to me?”
Abbot is chatting with Bridget at the desk but he’s clearly watching them, beginning of a frown on his face.
Langdon looks exasperated. He walks over to an empty bay and gestures for her to follow him in. Trinity doesn’t think he’ll try anything sketchy in the middle of the ER so she goes, and he pulls the curtain shut behind them.
His voice is low and tight, a fierce whisper.
“For Christ’s sake Santos, of all the people here, of course I’m going to believe you.”
She must look sceptical. He scrubs a hand through his hair, pushing it back from his face. She’s noticed it’s a kind of nervous tic for him.
“Santos, I worked in this ER, with these people, for 4 years, and not a single person noticed I was using. You found me out in one shift - less than one shift, it took you about 8 hours.”
Her mouth, without much input from her brain, manages to respond.
“It was outside perspective, it wasn’t special-”
“Oh screw that.”
He actually sounds angry now.
“Santos, I was working my ass off to keep my secrets and you saw through me like I was made of glass. So yeah, if you come to me and say we’re missing something, my instinct is to believe you, because out of everyone in this department yours are the eyes I trust the most.”
He’s red in the face as he pulls the curtain back.
“Got it?”
He storms off towards the ambulance bay. Everyone knows he’s become one of those fruit-flavoured disposable vape douchebags since rehab, and he takes his “smoke” breaks out there.
Abbot catches her eye from the charge desk and mouths “okay?” at her.
Trinity nods, shakes herself all over like a dog to pull herself back together, and goes to check if her shoulder dislocation has been assessed by vascular yet, because no matter how rocked she is by Langdon’s little speech the ER stops for no one.
She doesn’t know if it’s on purpose but she doesn’t have to work with Langdon for the rest of the shift, which passes in a blur.
It feels like it’s been no time at all when she hands her leftover patients to Whittaker, grabs her bag and heads off to her car. She chucks her stuff in the trunk and is thinking longingly about her shower (water pressure much improved since Whittaker moved in) when she straightens up and sees Langdon leaning against the wall of the parking garage, sucking furiously on his vape pen while he’s on the phone.
He hangs up and slumps against the concrete, looking exhausted. Trinity tries not to second guess what she’s about to do.
“You okay?”
He jumps a little in place.
“Uh, yeah. Fine. Just-”
He sighs.
“I’m staying with my parents right now, and my dad was supposed to come pick me up this morning but he forgot and I don’t want to rush him to come and get me but the bus takes forever and I was trying to decide whether Lena has forgiven me enough to let me crash in the on-call room until my next shift starts.”
Trinity only wrestles with her conscience for a second before she gives in.
“Get in the car, asshole, I’ll take you home.”
He blinks.
“You… don’t have to? It can’t be on your way.”
“No shit, but I’m not having you fucking up your back on the on-call room terrible bunk beds and relapsing and losing your job on my conscience because I wouldn’t drive a few miles out of my way. Although if you keep arguing I will abandon you, because I really need some sleep and all this talking is stopping me from getting it.”
He crosses the distance to her car hesitantly, and she points at his vape.
“You absolutely cannot use that thing in my car though. I’m sick enough of artificial strawberry smell leaking into work, I’m not taking it home with me.”
He sighs.
“It sucks, I know. I started smoking for real in rehab - everyone there did - but my wife refused to let me see my kids if I smelled like smoke and if I use the tobacco flavoured ones it just makes me miss actual cigarettes.”
Langdon looks so depressed by this statement that Trinity has to stop herself from laughing, and just waves at her passenger door.
He gets into the car without another word, except to tell her his parents’ address for her navigation app. They’re halfway there before he starts talking again.
“There was a study in Michigan about cognitive deficits after silent strokes - I could send it to you?”
Trinity takes a deep breath. Thinks about “yours are the eyes I trust the most”.
“Yeah, sure. Did you see the posterior shoulder dislocation earlier? I’d never seen one except on x-rays before.”
She can feel him brighten up in her passenger seat, and he starts talking about a gross open knee dislocation he’d seen as an intern.
They might never be friends, but this is okay. A professional working relationship is totally possible here.
Trinity tightens her hands on the wheel and keeps driving as the sun comes up.