Jared’s had a week from hell and it’s just typical that his pager goes off while he’s in the bathroom. By the time he gets down to the emergency room, the rest of the team are already doing their thing in resuscitation bay two. Morena’s getting handover from the paramedic; she acknowledges Jared's presence with a quick jerk of the head. There seem to be more police around the ER than usual.
He heads for the patient. It’s late Friday night, the guy crashed his car. Probably some fucking idiot driving drunk. Morena can fill him in on the nonessentials later.
White male, looks to be in his 30s. Collared and taped to a spine board, tube between bruised and split lips, eyes like a raccoon’s, minor lacerations over his face. Jared pulls on the gloves someone hands him and moves to the head of the stretcher, eyeballing the monitor as he passes. Heart rate, blood pressure, oxygen all fine.
He runs his fingers through the guy’s hair, checking for skull and scalp injuries. The light brown hair is matted in places with blood. Jared sniffs and revises his opinion of the man: there's none of the particular smell of alcohol-laced blood.
There’s bruising behind the left ear. Could be a skull fracture. Needs neuro. He tries to check the pupils, but the eyelids are swollen shut and he can’t open them. The facial lacerations are mostly minor and have stopped oozing. One on the forehead, though, is messy. Probably needs Plastics to suture that one. Shame to spoil this face. Jared’s seen a lot of beat-up faces and is pretty good by now at assessing what they look like without the damage. It looks like this guy took most of the force on his forehead; his nose and teeth aren't broken. Definitely need to scan the brain.
He moves down. More bruising, over the sternum. Jared again ups his opinion of the guy: he had a seatbelt on. Little bit of crunching on the right side of the chest, probably a couple of broken ribs. Belly soft though, probably no internal bleeding. Also, chiseled. This guy takes good care of himself. Apart from the whole hitting-something-at-90-mph thing.
He runs his hands down each arm, checking for breaks, as Hayley finishes cutting the man’s jeans off. The left lower leg is badly swollen and bruised. The other limbs are – well, in great shape. Really great shape, actually...
Morena finishes signing off on the ambulance paperwork and waves the clipboard at him. “Fearless Leader! Need your John Hancock.”
“Xray chest, pelvis, C-spine and left tib,” Jared tells Hayley, and scrawls something illegible in the “Trauma Team Leader” box.
X-ray hasn’t arrived yet, and Dan’s finished suturing the arterial line. “Time to turn,” Jared says, and the team move into position on the opposite side of the stretcher. Hayley stands at the head to count; she’s been exempt from turning duty since her pregnancy started to show.
“Okay, slowly over on three… One, two, three!”
Jared winces at the pressure marks already forming on the man’s lower back and shoulders. He feels down along the spine – “No steps, no instability,” – lubes one finger and briefly slides it up the guy’s ass. “No blood, rectal tone normal. Taking the spine board out, hold steady.”
He pulls the board out. The team roll the patient back on Hayley’s count. His wrecked clothes have been removed and Jared again registers how fit the man is, before Morena throws a johnny shirt over him. “Keep the collar on.”
X-ray peeks in around the door. He gives her a warm smile and waves her in; he can never remember her name.
She maneuvers her machine in and starts setting up. Hayley gives her instructions and flees; the rest of the team back off several feet. Jared peels off his gloves, rolling them inside out, and tosses them into the biohazard garbage as he steps outside the door.
Gen is standing there, carrying two coffees and a bakery bag.
“I could kiss you,” Jared says, and takes the coffee she holds out.
“Come sit,” she says, and without waiting for his protest, starts walking to the ER lounge. “It’ll take them at least 10 minutes and then he’ll go to scan. You have time to sit.”
Jared shuts his mouth and follows because she’s right. He’s just afraid that if he sits, he won’t get up again.
The lounge is by the back door of the ER. There are a couple more police and some hospital security guards standing around it. One of them eyeballs Gen appreciatively as she passes. She apparently fails to notice, but Jared’s seen that little hip shimmy before; she knows, and is enjoying it.
“Shameless, Cortese,” he says, when they’re ensconced in the lounge’s crappy chairs. The hospital replaces the stuff that visitors can see; the staff end up with last decade's brown-and-grey monstrosities.
She looks at him archly. “You’re the one who threw me out with the trash. I’m just sitting here on the curb, ready for pick-up.”
He opens his mouth to remonstrate: it’s not like that, he values her, he loves her, it just wasn’t going to be right for them in the long run… but she knows it all, she’s smiling and there’s no sting in her tone, and she’s holding out a blueberry streusel muffin. He fills his mouth with it instead of words. They eat in companionable silence for a couple of minutes.
“So,” she says, “spill. What happened to him?”
Jared squints, trying to remember what was on the paper Morena held out to him. “Belted driver, went off the road at high speed. Was braking and weaving pretty hard, hit the guardrail, and went through into the ditch.”
“Drunk,” Gen says and Jared shakes his head. She scrunches her eyebrows in disbelief. “Must have been.”
“Didn’t smell like it,” Jared says. “I haven't seen the tox screen yet, but I'd bet he wasn't.”
“Huh. Crazy. I wonder what happened. Maybe drugs? No way he just lost control.”
Jared watches her nibble the edges of her muffin paper clean. “I dunno. It's easy to get distracted for a second. People drive like morons on that stretch of the highway.”
Gen laughs. “You think he couldn’t cope with that?’
“What are you talking about? You know him?”
Gen narrows her eyes. “You’re kidding me.”
“What?” Jared shrugs, tipping up his cup to get the last swig of coffee. He never stirs in the sugar. He likes the way it gets sweeter at the end; it makes up for being colder.
Gen gapes at him. “You didn’t recognize him? Jared, that was Jensen Ackles. You know, the Formula One driver? The guy who used to be Nascar. It was a big story. Didn't you ever see him in the papers?”
Jared chokes on his drink. Gen whacks him on the back, spilling the last remaining coffee down the front of his scrubs. He glares at her and pulls away as she tries to mop his chest with paper napkins. “Shit. No way!”
She’s giving him her stern charge nurse look. “You didn’t check the patient’s name?”
“I dunno, I – Morena never said.”
Gen snorts. “Well, I’m not surprised Morena wouldn’t recognize the name – I don’t think she knows what Nascar is – but I can’t believe you didn’t even check your patient’s name.”
He’s suddenly really annoyed – partly at her for lecturing him, partly at himself for upholding the asshole-doctor stereotype. And partly at something he can’t put his finger on, something that’s shifted in the world and makes him feel too big and awkward and like he doesn’t fit. “He was all beat up and covered in blood and…”
He trails off as he recalls the images he's seen on TV and in print. He's not a huge fan of racing, but there are a few names it's hard to miss. And the press love Jensen. Not only has he come up out of nowhere, winning race after race for a previously low-ranked team, but he's their dream combination of someone who looks great on camera and can actually utter an intelligent sentence. Jensen Ackles has made it onto the cover of half the mens' magazines on the news stands over the last year.
Jared even bought a couple of them. Admittedly, Armani suits and studio lighting are a far cry from blood-stained jeans and the fluorescent strips of the ER, but now that he knows, he can't believe he didn't recognize the face or body he was examining so closely.
Jesus Christ. He stuck his finger up Jensen Ackles’ ass.
He lets out a strangled, slightly manic laugh. Gen is giving him a funny look.
“I, uh. Yeah.” He runs a hand through his hair. “That would explain all the extra security around here.”
Gen nods. “It'll be a zoo when the media gets wind of it.” She gives him a sympathetic look. “Good luck.”
“Thanks,” Jared says. “I'd better get over to the scanner. Thanks again for the coffee.”
“You can repay me with insider information,” Gen says slyly. “What the real Jensen Ackles is like. Maybe even introduce me.”
“I can't...” Jared starts to object, and realizes she's laughing again.
“Relax,” she says. “You'll do fine. A patient's a patient, celebrity or not. Just remember to ask their name next time.”
In the scanner’s tiny control room, three or four are a crowd. Jared elbows his way through the dozen or so bodies standing or sitting on every available surface. The neurosurgery chief resident is hovering behind the technician, tapping her foot impatiently. Jared settles for standing behind her; at five foot one, Aisha’s not exactly an impediment to his view.
The pictures start to come, one every couple of seconds.
“Head’s clean,” Aisha says to a subordinate. “Tell the OR to stand down.”
“There's a lot of bruising behind the ear,” Jared says.
She waves a hand dismissively. “Probably a basal skull fracture. I’ll have a look at the bone imaging when it comes up. Nothing to do, though.”
“You look at those,” Jared says, “and then you come by the ICU and do a proper exam and stick a monitor in him. This was a high impact trauma and I don’t care if the brain looks clean now, you guys keep a close eye on him.”
He surprises even himself with the vehemence in his tone. He chalks it up to nerves over having a celebrity patient. They can be trouble. Reporters trying to weasel medical details out of the staff; paparazzi hanging around; crowds of fans trying to sneak in. And that's when they're unconscious. When the VIPs start waking up and making demands, it can be enough to make the most patient nurses lose their cool. Thankfully, he's only heard stories about the worst ones. He's had some demanding patients, sure, but nobody mega-famous.
Aisha doesn’t roll her eyes while he can see, just nods and slips out the door. Her underlings follow.
Pictures keep coming, cross-sections of the chest and abdomen in high definition. Jared sends silent thanks to the donor who bought them the 64-slice scanner last year; the images are so much better than the crap the old machine used to give them.
He was right, a couple of broken ribs and mild lung contusions, but no major bleeding. The aorta’s okay, liver and spleen intact… Jared blinks as he feels his shoulders relax. He hadn’t realized how tense they’d been.
“Belly’s clear. Doesn’t look like he needs a chest tube?” The general surgery resident is edging for the door too.
“Nope,” Jared agrees. “You can take off. I want you to come check him tomorrow, though.”
“Sure thing. Thanks, Dr. P!” The guy makes his escape, along with a med student or two.
“X-rays show a tib-fib fracture on the left,” Jared's resident says. He's only a second year, but already has half a dozen publications in big-name orthopedics journals. Jared has already had to have a couple of chats with him about sleeping occasionally, eating actual food, and getting out into the sunlight more than once a month. He figures Osric'll go far – if he doesn't burn himself out early on. “There’s not a lot of displacement. I thought we could probably manage a closed reduction and cast it?”
Jared shakes his head.
“This guy’s gonna push,” he says. “You just know he’s gonna walk before we let him. I’m going with internal fixation on this one. Plus, it’ll get him into more active rehab earlier, which means less trouble with joint stiffness and muscle wasting.”
“Okay,” Osric says, looking crestfallen. He’s an excellent junior resident, one of the best Jared’s had in a while, but he takes it hard when he’s wrong, or thinks he’s wrong.
“This fracture could be managed either way,” Jared says. “Casting’s a reasonable option, and if he had more extensive injuries that were going to keep him down, I might do it. But look at it like this, Dr. Chau: this way, you get to go to the OR.”
That cheers him up. “Want me to book it? Level?”
“Three. And see if you can find some family to talk to for consent.”
Osric sketches a mock salute and races off.
“Will he be going to the OR directly?” the ICU resident asks.
Jared shakes his head again. “Cassidy’s room is still running, so we’ll have to wait. Maybe an hour.”
The guy nods. “Okay. I’d better get back. We'll get a bed ready. Who's the admitting physician?”
“He'll be under me,” Jared says. His overtired brain snickers at the double entendre, and moves on to appreciatively considering the possibilities for half a second, before being drowned in a wave of guilt and shock at his own unprofessionalism.
Jensen is a patient, for god's sake. His patient.
His tall, gorgeous, famous, well muscled patient who is absolutely and utterly off limits.
A very, very small part of Jared's brain spends a moment bitterly regretting that Jensen couldn't have come in on someone else's watch – say, Cassidy's – before being squelched.
“Great. See you there,” the ICU resident says, and takes off. Jared, the CT technician, a couple of nurses and a respiratory therapist are the only ones left.
The last of the images are up. Pelvis is fine.
“Anything else, Dr. P?” the tech inquires, and Jared shakes his head. “Looks good. Let's get him off the table and up to ICU.”
The others file into the scanner room. Jared lags behind, scrolling through the images once more to take a closer look. The radiologist will call him later with the final report, but Jared's seen enough scans to be pretty confident there's nothing major wrong. The head is still a little worrying – brains can take quite a hit without anything looking too bad, on the first scans at least – but it looks like Jensen Ackles is going to survive to tell his side of the story.
“He's going for the tube!” someone yells.
Jared leaps up and lunges through the door into the scanner. Jensen, apparently roused by being rolled and slid off the CT table onto the stretcher, is showing the first signs of purposeful activity Jared's seen in him, which unfortunately consist of bringing his right hand up to his mouth and getting a firm grip on the tube currently down his windpipe.
One nurse has both hands on his right arm, trying to prevent him from moving it and pulling out the tube, but it's clearly taking all she's got to resist his strength. The radiology tech is holding his other arm down, and the CT tech has his legs, while the other nurse is swiftly wiping down the nearest IV access port with disinfectant and preparing to inject more sedation.
Jared steps up and peels Jensen's fingers off the tube, speaking in a calm voice. “It's okay. Let go of that. You're in the hospital. You had a bad accident, but you're doing okay. That's a tube in there to help you breathe. We'll get it out as soon as we can, but you've gotta let go of it now, okay?”
Before he's even finished speaking, the hand struggling against his relaxes as the intravenous sedation hits the brain. Jensen goes limp.
“Moving well, with good strength,” the nurse says, letting go of his arm. “I guess that's a good sign? Sorry, though, I didn't see that coming. He seemed completely snowed. Thanks for your help.”
“No problem. Thanks for catching it in time,” Jared says. “What's the propofol running at?”
“Ten mils an hour.”
“Up it to fifteen. He's a big guy.”
“Okay. We're keeping him sedated overnight?”
“Probably,” Jared says. “At least, until he goes to the OR. I asked neuro to stick a pressure monitor in him. His brain scan looks good, so unless there's any problem with pressure, we'll probably try and wake him up tomorrow.”
She nods. “Sounds good.” She reaches down to the foot of the bed and pulls up the blankets folded there. Jared notices her brow furrowing quizzically, and abruptly realizes he's still holding Jensen's hand in his.
He lowers it to the bed. “Pulse good and strong.” He wasn't really holding it in such a way as to check the pulse, but it's all he can think of.
She looks up to the head of the bed, where her colleague has the transport monitor hooked up and the RT has attached the oxygen tank. “Cool. We ready to roll?”
“Want a hand?” Jared offers.
“Oh no, thanks, Dr. Padalecki. We're fine.” She smiles. “You better get something to eat if you're going to the OR.”
Jared smiles back. “I just had a snack, but thanks. I'll go make sure they're setting up.”
He watches them push the stretcher down the hallway, and frowns. Jesus, Jared. Get a grip. And not on your fucking patient.
It's the weirdness of the situation, that's all. He's not used to operating on someone he's seen on TV. It's late night, he's not firing on all cylinders. He cannot possibly be dumb or perverted enough to even contemplate what it might be like to break one of the most basic tenets of professional ethics: lusting after a patient. An unconscious one at that. Fuck.
He just needs to get into surgery. That always clears his head.
A lot of people say anesthesia's like flying a plane: the tough parts are the take-off and landing. A lot of people also like to joke about what anesthesiologists do during the long flight in between. Namely, drink coffee, do sudoku, check their stock prices.
A lot of people haven't got a clue what they're talking about. Sadly, some of them are surgeons. Jared's got colleagues all too ready to trash talk the person at the other end of the table who's making sure their patient doesn't die, suffer brain damage, or wake up in the middle of their hip replacement.
Nobody talks that way about Chris, though. For one thing, he's absolutely fucking brilliant at what he does – even if he attributes it to a misguided youth spent exploring the seedier side of pharmacology. More importantly, nothing seems to faze him. Massive blood loss, medical wrecks, difficult airways, drug addicts: he takes it all in stride and does his job coolly and without fuss.
And then there's the fact he could probably take down any of them, even Tom from Plastics who's built like a brick shithouse.
“Dr. Padalecki,” Chris says, with only a faint hint of mockery, when Jared arrives in the OR. Jensen's already been transferred onto the OR table, and his ventilation tube is now feeding him anesthetic gas along with oxygenated air. “Glad you could make it.”
“Wouldn't miss it, Dr. Kane,” Jared replies, keeping his face straight. “Though I'm sure Dr. Chau had it all under control.”
Osric's sitting cross-legged on a tiny spare steel table on wheels, writing orders in the chart. It's a precarious perch; he startles at that and nearly falls off.
“Careful,” Jared advises him. “We don't want to be operating on you next.”
“You nervous?” Chris says.
Jared shrugs. “Why would I be?” He walks over to the large computer screen on the far wall, leaving Chris to apply monitors and get the drugs running while he pulls up the X-rays for the case.
He knows the answer, of course. It's tempting Fate to operate on a VIP. If anyone's going to have a hitherto unimaginable complication, it's them. Jensen's probably going to fall off the operating table and break his jaw, or get gangrene. Possibly the sterile drapes will catch fire, or the operating lamp will fall off the ceiling and crush both Jensen and Jared. Maybe Chris's anesthetic machine will explode.
Or maybe Jared'll make a tiny mistake, one that ninety-nine times out of a hundred would usually heal without any ill effects, and Jensen Ackles will never drive or walk without pain again.
Every operation carries its risks. It takes a certain level of confidence – arrogance, even – to cut into someone's flesh. An act of controlled violence, with the best of intentions. Things can go badly without it being anyone's fault. But in the end, the triumphs and the failures alike belong to the surgeon.
“Every surgeon carries a graveyard within himself,” a mentor had told him. Jared has a few graves he visits from time to time, on dark nights.
This is not the time to dwell on them, though. This is the time to breathe deliberately, visualize the actions he's done hundreds of times, mentally rehearse the variation he expects for this case based on the X-rays.
This is the time to narrow down and forget who he's operating on – forget it's a person, even – and focus on the materials in front of him. Skin. Muscle. Bone. Blood vessels. Nerves. Things that are broken and need to be fixed; things that are out of place and need to be rearranged.
“Ready for time out?” the scrub nurse says, summoning his attention back to the room.
“Jensen Ackles. Internal fixation for left tibial fracture. Left side is marked, imaging is displayed. No allergies. Antibiotics?”
“Two grams cefazolin, in,” Chris says. “Came from ICU, going back there. Warming blanket on.”
“We've got the plates?” It's a formality, asking: Jared can see them on the setup.
“Yes,” the scrub nurse reassures him.
“Okay,” Jared says. “Anybody got any concerns?”
“Time out complete,” he says. “I'm going to scrub. Can you prep?”
By the time he comes back in, sterile blue drapes cover the whole bed. Only the left lower leg, painted in brightly colored disinfectant and positioned in the traction frame, is exposed. Dissociated from a visible person, it is a task, a target, a job to do. He takes the knife, and begins. Across from him, Osric holds things, retracts, mops away blood, keeping his field clear.
His fingers probe the inside of the limb. He’s struck by the intimacy of the act, as he has been many times before. Only a thin layer of latex separates his skin from the inside of another person’s body. The sterile, blue drapes frame a small window into the flesh.
He manipulates lax muscle and bone, aligning the fragments perfectly. He measures, chooses a plate, checks it against the bone. Perfect.
“Hold this steady,” he says to Osric. “Drill.”
Tiny holes, punched through the tough outer layer of the bone, matching up with the holes on the plate. The bone is very solid, as he'd expect in a young, active guy. It's good: it means the screws should hold against the forces that will inevitably try to rip them out. He'll still have to keep Jensen from taking any amount of weight on the leg for at least a month or two.
“Screw to Osric,” he says.
Osric starts. “Seriously?”
“You're here to operate, Dr. Chau,” Jared says. “I trust you know how to work a screwdriver.”
“Yes, of course, I just...” Osric grins behind the mask, corners of his eyes crinkling, and takes the loaded screwdriver from the scrub nurse.
“I'll fix it if you fuck it up,” Jared says. “But you won't, will you?”
Osric shakes his head, not taking his eyes off the screw he's carefully placing through the hole at the top of the plate. “No sir!”
“Nice job,” Jared says when all the screws are placed, eyeing the brightly colored metal construct holding the bone together. It always amuses him that they're so pretty, purple and green and blue titanium, candy colors that nobody else will ever see. “Close it up.”
Osric's eyes widen again, but he holds out his right hand, palm up, towards the nurse. “Two-oh Vicryl.” She slaps it into his hand.
Jared watches him like a hawk as he sews, pulling the layers together. Occasionally he interjects with comments like “Too much tension,” or “Take a deeper bite,” but mostly he's satisfied with what he sees. Osric isn't just good at studying and research; he's got good hands.
They finish closing, apply bandages, and remove the drapes.
“What's your plan for sedation?” Chris asks. “Wanna keep him asleep overnight?”
Jared looks at the clock. There's not a lot of night left.
“Might as well. I asked neuro to check on him once we get him settled back in ICU.”
They get Jensen transferred back onto the ICU bed and hooked up to a transport monitor, then wheel him over to the ICU. Jared checks Osric's orders, tells the nurses the same things two or three times over, asks them to make sure and page Aisha to come, and generally fusses until the ICU attending gently but firmly tells him that they know what they're doing, thanks, and why doesn't he go home and get some sleep?
It's three a.m. by now and this sounds like the best idea Jared's heard in weeks. He's still got the rest of the weekend to get through.
“Call me,” he says. “With anything at all.”
Osric and the ICU attending both assure him they will, and he goes home and sleeps as deeply, and probably more peacefully, as any heavily sedated ICU patient. He has just enough presence of mind, before falling into bed, to put his phone in the metal garbage can beside the bed. Long experience has taught him that even on maximum ringer, he can sleep right through it ringing, but amplification helps.
The loud – and amplified – chime of his alarm blasts him awake as the sun is just beginning to creep in his bedroom window. He startles awake, sitting bolt upright with heart racing, and then groans and flops back down, rolling over to grope with one arm off the edge of the bed. He locates and removes the phone from its resonant home, silencing it.
“Urgh,” he mutters, staring at the ceiling. His brain and body are colluding, urging him to sink back into sleep, but years of habit kick in and he's staggering to the shower, eyes still shut, before his brain can consciously register or object to this.
The water gets him halfway to a state that might charitably be called 'awake', and by the time he's towelling off, the smell of coffee is drifting from the kitchen and his stomach is on board with the idea of breakfast. That's most of the battle: there'd be no going back to sleep now. If there's any lingering sleepiness after he's eaten, it won't survive the run to work.
Jared almost never drives to work. One of these days, he'll get out of the city, get a big place with a big yard, space for friends and family to stay and a dog – maybe several dogs – to run around. He could get a place like that for what he pays now for his downtown apartment, but for now, this is enough. It's big and luxurious by a lot of city people's standards, but it's small enough he doesn't feel lonely rattling around in it by himself, and it means he's near enough the hospital he can run or bike there for anything but the most urgent cases. There are weeks so busy that the run to and from work is the only exercise he gets.
More than that, though, the run is a chance to clear his head. Prepare for the day ahead, or let go of things.
The sidewalks are nearly empty this early on a Saturday morning, and the streets aren't yet clogged with cars. The sun is still low on the horizon, the air cool on his heated skin.
As Jared approaches the hospital, he sees groups of people clustered around the front entrance plaza. He jogs a little closer until he can make out details. The people nearest the door are a line-up of hospital security; beyond them are small tight groups of mostly men with cameras. There are far more people than usual for a very early Saturday morning, standing around the bottom of the stairs or sitting on the benches of the plaza with phones and take-away coffee cups.
He keeps his head down and runs right past, around the corner of the block, and goes in through an ambulance bay in the ER. There are extra security folks here, as well, ones he's never seen before, but there are no paparazzi he can see and his ID gets him through.
He takes the staff-only elevator up to the OR complex, has a quick shower, and changes into scrubs. He briefly considers putting a shirt and tie on for ward rounds – he's always got a couple of clean changes of clothes in his locker – but dismisses it. Today's going to be busy, potentially messy. Kylie's cast needs to be cut and reshaped, Mr. Barnes needs his external fixator adjusted. And he'll have to be involved in a hands-on way, since today he's stuck with a resident even more junior than Osric.
Don't you want to look your professional best in front of... your patients? his brain hints.
He cringes at his own thought and slams his locker door. No, Jared, he admonishes himself. No, you should not be making an effort to look your best for a man who is famous and stupidly hot and your damn patient. Scrubs are totally professional.
He's annoyed enough at himself that he deliberately doesn't check his hair in the mirror before he leaves, just runs his hands through it a couple of times.
Plus, Jensen's probably still totally unconscious.
He heads for the ICU first. Completely justifiable. They're the sickest and most unstable patients.
Jensen is no longer totally unconscious. He also no longer has a breathing tube in.
“He self-extubated around seven a.m.” the ICU resident admits. He cringes under Jared's glare. “We were weaning the sedation slowly, but he woke up with a bang and pulled the tube out before anyone could get in the room.”
“He tried that in the scanner,” Jared growls. “How come nobody was watching for it?”
Jensen's nurse steps out of the glass-doored room.
“Now that's not fair, Dr. P.”
Fletcher is one of the senior nurses on the unit. Families love him, and in his years in ICU and before that the ER, he's seen almost everything. He's a fantastically knowledgeable team member and also just a really nice guy; Jared's never seen him lose his temper with anyone. “Even with one-on-one nursing, we can't be in there all the time, and I wasn't gonna tie him down. He'd been on the lower dose for at least fifteen minutes. I didn't think he was going to wake up until I dropped the dose again.”
“Didn't you have an EEG monitor on him?” Jared demands. “What about the brain pressure sensor?”
“No,” Fletcher says, “we didn't. And before you flip out, his head's fine. Neuro came and checked on him – Dr. Collins himself came by. They decided he didn't need invasive monitoring. Which,” he presses on, forestalling Jared's objections, “is their call. And it appears they were right.”
Jared sighs. “Sorry, Fletch. I'm just worried about him.”
“I know. But you don't need to be. He flew fine without the tube, no harm done.” Fletcher spreads his hands apologetically. “Sorry it happened that way.”
“How's his breathing?” Jared looks through the glass. Jensen's chest is rising and falling in a regular rhythm, and the numbers on the monitor all look fine.
“He's a little uncomfortable with those fractured ribs, but we've got him on some morphine. His oxygen sats have been fine. We'll get him doing chest physio later today, when he wakes up again.” He gestures through the glass at his peacefully sleeping patient. “This is pretty much just exhaustion.”
“Dr. Padalecki!” Today's on-call resident comes tearing up and slides to a stop beside Jared. He's even more junior than Osric. Jared had groaned internally when he saw the call schedule for this weekend; juniors mean he spends a lot more time in the hospital. This one looks like he's still in the gangly phase of high school. He's very keen, though. “Sorry, I didn't know you were rounding. Anything you need to know, I'm on it.” He pulls an iPad out of his lab coat pocket and brandishes it, narrowly missing Jared's face. “Lab values, X-rays, discharge plans, I've got it all. Just say the word.”
“Thanks, DJ,” Jared says. “For now, though, let's have a look at the actual patient.”
The two of them walk to the bedside, as Fletcher sits down outside to write his notes in the chart. Jared takes a good look at the still-sleeping Jensen. His face looks worse than yesterday, with more bruising and swelling around the eyes; he probably won't be able to open them today. Plastics has been by and sutured the facial lacerations. The oxygen tubing running under his nose is carefully taped to his face in a squiggly pattern that avoids the cuts.
Jensen has freckles standing out across his nose and cheeks. They're cute, but Jared doesn't remember seeing them in all those magazine photos. Maybe they'd been airbrushed out, or maybe Jensen's anemic. Maybe they missed some internal bleeding. His belly CT was fine, his brain reminds him before he gets fully into panic mode.
“What's his hemoglobin?”
“Ten point four,” DJ supplies, tapping at his iPad. “Sodium one thirty-eight, potassium four point two, chloride...”
“It's okay, I don't need to know all the numbers,” Jared says. “Just the abnormal ones.”
DJ scans through columns of numbers, squinting at the screen. “Not much abnormal. Just that hemoglobin a bit low. Not enough to transfuse.”
“What about the pedal pulses?”
DJ goes paler than Jensen. “Uh. I didn't check, sir.”
Jared gives him a mildly reproachful look. He's got a whole repertoire of looks for the residents, ranging from faint disappointment to death glare – plus a similar range of encouraging ones – but his sense is that he needs to take it easy on DJ for now.
“That's your job,” he says. “All the other stuff you're telling me, it's good to know, you need to check it. But ICU, the nurses... they'll check that too. You're the ortho resident: you need to check the things that relate to orthopedics, to the surgery we did – or didn't do – because nobody else is going to check that. Or if they do, they might not know what they're looking at.”
DJ gives a nervous grin. “I might not either.”
“I know,” Jared says, and gives him a small half-smile of reassurance. “That's what the next five years are for.”
He looks down. Jensen hasn't moved, hasn't even flickered an eyelid, throughout their conversation. “Mr. Ackles?” he says, once and then a little louder. “It's the doctors. We need to have a look at your leg, okay?”
Jensen sleeps on. Jared can't blame him. He'd barely managed to get up himself, and he hadn't had nearly as rough a night as Jensen.
“I'm just going to have a look now,” he says, and tugs the bedspread free from the foot of the bed. He pulls it up to expose Jensen's legs to just above the knees. The right leg looks fine, although there's a little bruising becoming evident today. The left is definitely swollen, but it doesn't look worse than yesterday and the bandages are clean. There's a blue pen line drawn around a small blood stain. It isn't spreading, though, which is good.
He gently lays the pads of his index and middle fingers over the arch of Jensen's left foot, then slides them to the inside of the ankle below the bone.
“Both good and strong,” he says, and gestures to DJ to check the same spots. It takes DJ a few moments to find the right spot, but his eyes light up when he does. He nods.
“You'll remember next time,” Jared says, and DJ nods vigorously. He pulls the covers back down over Jensen's feet, glancing back up at his face, but the man in the bed is still soundly asleep. “Circulation problems are rare, but if you don't spot it in time, they can lose function in the limb. And you'll miss it for sure if you don't look.”
DJ nods so hard he looks like a weirdly-proportioned bobble-head doll. “Absolutely. Thanks, Dr. P.”
Jared leaves the room, sparing one more glance back at Jensen.
“See?” Fletcher says, gesturing at Jared with his pen. “He's fine.”
“You're keeping him here over the weekend, though.”
Fletcher's back to writing. He doesn't say no, but he doesn't say yes either.
“Right?” Jared demands.
“Not up to me, Dr. P.”
Jared almost snaps at him, but he bites it back. Fletcher's correct, of course. And Jensen's fine; Jared's being irrationally concerned about him.
He once again admonishes himself to get a grip and heads off to find the ICU resident, to strongly suggest that Jensen be kept in the ICU until Monday. The resident nervously points out that they might need the bed, and if Jensen's well enough maybe he could be transferred to the regular ward earlier, but Jared glares at him and he desists, muttering apologies again about the tube.
Up on the ward, Maggie greets him with her usual big smile. “Hi, Dr. Padalecki!” Maggie’s been the clerk on the sixth floor orthopedic ward forever and nothing ever gets her rattled. “I hear you're going to be bringing us a celebrity!”
She winks at Ashley, the charge nurse who’s hurried up to see what Jared wants. “I also heard you didn’t even recognize him. With a face like that!” She clasps her hands to her chest, mock swooning. “I can't wait to have him prettying up our little corner of this place.”
Jared laughs. “You might not recognize him.”
Maggie sobers immediately. “Oh no. Is it bad? We heard you just had to plate the leg. I didn't mean...”
“No, it's okay,” Jared hastily reassures her. “He's going to be fine. He's pretty banged-up, is all.” He winks. “I think he'll be back to his good-looking self for you again soon.”
“Excellent,” Maggie beams, good humor restored. She gestures to the room directly across the hallway from her desk. “I'll put him right in there.”
“Shall we?” Jared says, turning to Ashley. DJ falls in behind them as they set off to go around the ward.
On the weekend, he looks in on all the in-patients, although he usually spends a little more time chatting with his own patients. Today he inspects wounds, writes orders for a couple of patients who've been on bedrest to get up and walking, adjusts the external fixator that's keeping Mr. Barnes' pelvic fracture steady, and cuts Kylie's cast along the edges in a clam-shell fashion.
DJ's pager goes off several times during rounds. Some are minor questions he can deal with over the phone, but then the ER phones with a couple of consults. Jared sends him off to deal with them, finishes rounds, and heads for his office to do some paperwork. There's no point in going home; he'll have to review the ER patients within an hour or two.
He goes to grab a quick bite of lunch, and eats in the surgeons' lounge instead of the cafeteria. Less chance of interruption from worried families. The TV is on low in the background, and he sees a news item about Jensen. It says the crash is under investigation, and that Mr. Ackles is in serious but stable condition in the local hospital.
Jared contemplates swinging by the ICU again to check on things, but his pager goes off and it's DJ, and from then on in the day is crazy.