Chapter Text
Robby was going on day 4 of a nicotine-withdrawal induced headache. He was leaning against the wall in the breakroom waiting for coffee to brew when he heard the crash—loud, mechanical, and close. Through the window he could see people streaming to the ambulance bay, and he sighed, praying that his motorcycle hadn’t fallen victim to an ambulance again.
Reluctantly, he followed the crowd outside, taking in the scene. A minivan lay on its side, crushing the PTCM bike rack—it looked like it had struck a curb at speed and flipped, and the driver was—shit—it looked like the driver was a kid. “Someone call FD,” Robby instructed, slipping gloves out of his pocket. “Donnie, grab a stepladder from EVS, we need to get up in there. Someone find Jack.”
“I’m here,” he grunted from behind Robby.
Robby dropped to his knees to peer through spider-webbed windshield. “Driver and passenger both unconscious, can’t see if there’s anyone else. Get two gurneys ready with c-collars. Passenger has blunt head trauma, does not appear to be wearing a seatbelt. Driver…driver was wearing a seatbelt. He’s a minor.” He stood again, thinking quickly, but noticed the kid stirring. “He’s waking up—someone check if you can get in through the back—hey, hey kiddo.” The boy looked up, squinting. “My name’s Dr. Robby. You’re at the hospital, but you were in a car accident. We’re gonna help you. Can you tell us your name?”
“…Matt.”
“Okay, Matt, thank you. Can you tell me if anything hurts?”
The boy blinked slowly, and Robby could tell that his words were taking a moment to sink in. “My dad,” he said suddenly, looking around.
“Matt—stop, stop moving, please. Your dad is next to you. We think he hurt his head in the crash, but were you driving him here? Is something else wrong?”
“He hit his head before, and he was really sleepy, but he said not to call an ambulance? But I didn’t know what else to do, and he let me drive in parking lots sometimes, and I just thought—”
“Matt, you did good,” Robby said, breaking the kid out of his spiral. “We’re working on getting you and your dad out, just please stay put.”
“Is she okay?”
“Who?”
“The woman…by the bike rack.”
Fuck. Jack was already moving; Robby gestured for Donnie to come closer with the ladder. “Get up there and talk with him. Keep him calm.” He scooted around the van, slipping between the front bumper and a pillar by the entrance. The gap was littered with a fresh graveyard of bicycle parts, but in the back corner Robby could see a helmet.
A familiar helmet.
“Samira,” he breathed. Only her head and shoulders were visible, the rest of her was buried under an amalgam of bike and minivan. She was being crushed.
“I can’t get through there,” Jack said tersely. “Going around the other side.”
Robby was already moving, picking his way through the wreckage. There was a tiny patch of concrete where he could kneel, maybe a foot away from her. It would have to work. “Samira!” he called. He automatically reached for her pulse, his own heart tightening as he counted it out. She was tachycardic, but a fast pulse was better than no pulse. “Samira!” He patted her face, then rubbed her sternum, finally getting a reaction.
“Hmm…?” Samira breathed, trying to roll away.
“Samira, look at me, look right here. You were in an accident.” Robby could feel eyes on his back—half the ED was swarmed around the car—but she was so closed in that no one could get to her but Robby. “We’re gonna take care of you, okay? Can you tell me if anything hurts?”
Her eyes wandered, slowly taking in the scene, and she lifted her head to look. “Oh, god…oh my god. What…oh, god.”
“Samira! Samira, don’t look there, look at me. Tell me what you can feel. Start with your head, work your way down.”
“Um. Head…fuzzy. But doesn’t hurt, I think.”
“Arms?”
She exhaled, a short, fast breath that Robby catalogued—her lungs were probably having trouble expanding under the pressure. “Arms...AH! Fuck…left…” she gasped. “Left…out of socket. I think…fractured wrist.”
“Can you feel your fingers?”
“Yes—fuck.” She was panting now, eyes shut against the pain.
“Focus, Samira,” Robby said sharply. “Right arm.”
“Right arm…I can feel. It’s…wet. I…I don’t know what it is.”
“Chest?”
“Having some trouble…breathing…” she whispered. Her eyes flicked up to Robby’s, full of fear. “Can’t take…a deep breath.”
“I’ve heard that can happen with a car on your chest.”
She gave him a mix of a grimace and a weak smile, and Robby’s heart tightened again. “Ribs?”
“Just…pressure. Pelvis too…and my legs…” she licked her lips, waiting a few beats. “I can’t feel them at all.”
Robby needed to stay calm, for Samira’s sake. “Again…car,” he said with a smile. “Nothing we are gonna worry about right now, okay? We’re gonna get you some fluids to stave off the shock, and some fentanyl, does that sound good?” She nodded. “I need to stand up and talk with Jack. I’m gonna be right back, okay? Samira?”
“Mmhmm.” It seemed like she was fading, and Robby hesitated, but Dana had popped up at the front bumper.
“Dana’s gonna stay with you for a second, okay? Just a few seconds.” He squeezed her right shoulder and hefted himself to his feet, picking his way out of the bikes. When he traded space with Dana, he pulled her back for a second. “Keep her from moving, keep her calm. She can’t feel a lot of her body…and that’s a good thing right now.” Dana nodded resolutely and ducked down, and Robby turned to face Jack.
“Fire’s on their way,” Jack said. “The boy’s fine, Shen’s working on the father. But the chances of getting him back with a head injury and a heart attack…”
“Small.” But Robby was focused on his current patient, already rummaging through their trauma kit and grabbing what he needed. “She’s got a dislocated left shoulder and broken wrist, depressed breathing. Can feel pressure on her chest but nothing under that.”
“Shit.”
“Yeah. Best we can do is push crystalloid, monitor for hyperkalemia, and wait. And someone tell Fire to get their asses in gear.” He grabbed the IV bag.
“You’re going to have to put in the IV in the jugular.”
“Yeah.” The two men stared at each other, understanding flowing between them. This was…it was life and death. Samira was alert and talking now, but she could die the second they lifted the van, and there’s nothing they would be able to do to stop it.
“You’ve got this, brother.”
Robby nodded wordlessly and switched out again with Dana. He studied Samira’s face, trying to decide if it looked a shade lighter than it did when he stepped away. “Hey, Samira. How’re you doing?”
“Could use…some fent.”
“Let’s get that going then. Tell me, without limb access, where would I want to set the IV?” He could see the wheels turning languidly in her brain, and her old nickname came to mind—Slowmo. He regretted ever calling her that.
She swallowed hard. “Jugular?”
“Yup. You’ve seen me do it before. You know the process. You don’t need to be scared.”
“M’not.”
“Good. Close your eyes.” Robby did it quickly, ignoring her small flinch, and squeezed the fluids in.
“Feels weird.”
“I know. Fent should start working any second now, you’ll get a little floaty.” She blinked, and a tear slipped out of her eye. “Hey, none of that. You’re going to be fine.”
“Crush syndrome,” she whispered. “If it takes much longer…my kidneys…”
“We know. That’s why we’re pushing fluids and monitoring your potassium. Dana took some blood and we’re gonna put you on ECG. You don’t have to worry about anything, Samira.”
“Mm.”
“But…if there’s anyone you want to call…”
Tears gathered in her eyes again. “My mom?”
“Your mom, yeah, of course. Do you know her number?”
“It’s in my phone…”
Robby looked around, but didn’t see any phone or bag. “Is she your emergency contact? We can get her number off the records.”
“No…she lives too far away.”
“Okay. We’re gonna figure it out, okay? What about recording a message for her? Yeah?” Samira nodded. Robby’s hands shook as he held the phone for her. This was getting way too real. “Okay, ready…3…2…1…”
She took a shuddering breath. “Hi, mom. It’s Sami. Um…something happened? And I don’t know if I…” She cut off, shaking her head. “No, I need to…to start over…”
“Okay, no problem,” he said gently. “3…2…1…”
“Hi, Amma. I wanted to tell you…that I love you. I miss you…so much. You were always there for me, after Appa died…” she broke off again, her breaths coming fast and shallow. “Oh, god, I don’t…know what…to say.”
“Ho’oponopono,” Robby found himself saying.
“I love you.” You’re one of my best residents, and a friend.
“Thank you.” You make me better; you make the whole department better.
“I forgive you.” You called me out when I needed it.
“…please forgive me.” Oh, god, Samira, please forgive me for everything.
She nodded. “Again.”
Again? Belatedly, Robby recognized the phone still in his hand. “3…2…1…”
“Amma. I love you so much, and I miss you. Thank you for…everything. For being there after Appa…for taking care of me. I know we’ve had our differences, but…I have nothing but love for you. Please forgive me…for pushing you away? I’m sorry. I love you.” Her eyes closed, lip trembling, and Robby put his hand on her shoulder again, hoping it was comforting. “Okay.”
Robby stopped the recording. “Okay.” They sat in silence, just…waiting.
Robby watched the portable monitor Dana had wedged by her head, and didn’t like what he saw, but finally there were sirens in the distance. “You hear that, Samira? You hear the sirens? We’re going to get this van off you, how does that sound?”
“Hm. Good,” she said breathily.
“How’s the breathing?”
“Getting…tired.”
When Robby turned back, Jack’s hand was already handing over the portable oxygen tank. Robby nodded his thanks and wordlessly pressed the mask over her face. “They’re so close,” he murmured. “Going to push another bag of fluids now.”
Jack’s hands were there again, handing over a new IV bag. “I’ll manage from this side, brother. You two stay put.”
“Not…going anywhere,” Samira slurred.
“Hang in there, kid.”
The sirens cut out, leaving an emptiness that echoed just as loud. “Robby?”
“Yeah?”
“’m scared.”
“It’s okay to be scared,” he said, his voice as soft as it’s ever been. “This is a scary situation.”
“I wish…I didn’t know…what can happen?”
Robby wishes she didn’t either. “Try not to think about that. Think about…the miracle patients. That pregnant mother from a few months ago that got t-boned and wasn’t found until hours later—she walked away two days later, remember?”
“Mm.” Her vitals were dropping now, not quickly, but…noticeably. Her responses were slowing.
He squeezed the bag of fluids harder. “Stay with me, Samira.”
“Dr. Robinavitch?” Robby looked back over his shoulder to see the fire captain. “We’re setting up now to pull the car back upright. Maybe three minutes. How’s she doing?”
“Declining. Make it fast.”
“You got it. Let me check with the team.”
“You hear that? We’re gonna pull the car off and get you inside.”
“…cold,” she murmured. She was lost; shock was taking over, and that was maybe a blessing in disguise. Robby squeezed the fluids. All of his years of school, and residency, and running a major trauma center, and all he could do was push fluids and wait.
“Come on,” he murmured under his breath.
“Robby!” Jack called. “We’re going!” There was a grinding noise, and the groaning of metal, and it wasn’t happening fast enough. Robby turned on his phone flashlight and aimed it under the car, trying to make sense of what he was seeing. There was a bike that looked like it had snapped in half, somehow, and half of it was lying on its side…and the other half was jammed through Samira’s stomach.
The minivan was pulled all the way off, and daylight illuminated the rest of the bloody picture. His phone long forgotten, Robby climbed closer, putting pressure on the wound even before the van settled right-side up again. “JACK!” he yelled, but the man was already next to him, flinging bike parts. “Someone get a saw, we need to cut off the frame so we can move her.”
Dana was at Samira’s head, comforting the barely-conscious resident. “You did so good, baby. We’ve got you, just keep those eyes open for me, hm?”
“Broken femur, broken tib fib, weak pulses in both.” Jack listed urgently. “But pelvis feels stable.”
“How’s her breathing?” Now that his hands were busy holding pressure, Robby was stuck again, unable to help. But if he let up at all…he forced the thought out of his head.
“Diminished breath sounds on the left. Hemothorax, need a chest tube.” Hands were there immediately, Frank handing over a chest tube and Princess the scalpel. Javadi was hovering behind Dana, pushing a bag of blood.
Someone draped a fire coat over Robby as the saw was brought in, slowly cutting through the bike frame. Robby glanced up at Samira’s face—pale and scared, but still awake. Still alive. “3…2…1…up,” someone said, and Robby lifted with them, and stretched to maintain pressure as they set her on the gurney.
The path to trauma 1 went fast—the pitt had never worked more efficiently—but the room was cramped with people. “Get ‘em out of here, Dana,” he warned. Walsh and Garcia were waiting with a rad tech, and swooped in.
“Remove pressure, Robby,” Walsh ordered.
“I got it; I’ll take her up.”
“Robby, now.”
Jack’s hands were on Robby’s, just resting, not pulling. “Robby, let go,” he commanded.
Robby let go. He stepped back, watching. Jack had gotten the chest tube in; oxygen stats were better. The monitor hadn’t picked up any arrythmias. Dana took another blood sample to test for hyperkalemia. Emery packed around the wound. Things were under control.
Things didn’t feel under control.
He was waiting for the other shoe to drop, waiting for crush syndrome to kick in. Any second, things could go downhill.
“Walsh, ready to move?” Garcia asked.
“Let me tie this off…yes, let’s go.”
The transpo team wheeled Samira out as quickly as she had been wheeled in, and Robby went to follow until he was stopped by an arm bar across the door. “Not you,” Jack said.
“Jack—”
“No. Go get cleaned up.”
“I just want to make sure she gets upstairs okay.”
“There’s a whole team of people with her, man, you know you’re just going to get in the way.”
Robby glared, but Jack didn’t flinch. “Fine.”
He stopped at the first sink he found. The gloves had kept his hands clean, but there was a sick line of blood ringing his wrists where the gloves stopped, congealing in his wiry arm hair. It pulled as he scrubbed, and he kept finding new smears on the outside of his arms, and his cheek, and his forehead. He might throw up if he thought about whose blood it was.
Once his arms were pink and sterile, he grabbed a towel and took the time to dry in between each finger and up each wrist. He watched the pitt, bustling again, but with a dangerous undercurrent—Samira was the one upstairs, but they had all suffered a trauma that morning.
“Hey,” Dana said softly as he approached central. “She made it up to the OR, still stable.”
“Whaddya got for me?”
“Abbot’s covering.”
Robby huffed. “I’ll take over for him, then.”
“Won’t hurt anyone if you take a minute.”
“I don’t need a minute.” He grabbed a tablet. “It’s an emergency, it was handled. That’s what we do here.” He ran away before she could give him any more disapproving looks.
It’s just another day, he kept reminding himself. Patients came in, patients went out. But as the day went on, Robby noticed something…no one had died. Not in the silver flood from the nursing home, not the dad from the crash, not anyone sitting in the waiting room for hours.
On a normal day, he’d be celebrating.
Much as he hated to admit it, today wasn’t any other day. Today, his resident—his friend—was in the OR, and he kept looking over his shoulder, waiting for the other shoe to drop. When the elevator dinged open and Walsh walked out, Robby went weak in the knees.
Her expression was impossible to read as she walked over to him, pulling the attention of everyone else in the ER like a magnet. “There was extensive damage. She coded once on the table, but…we got her back. She’s stable. It’s a long journey, but…”
Robby could barely breathe. “She’s gonna be okay?”
Walsh finally smiled. “She’s going to be fine.”