Honor careened into the lot opposite the emergency trauma entrance and pulled her car into the first free spot she could see. As she ran across the lot, helicopters circled overhead, descending to the trauma landing zone atop the building. The distant sirens of approaching emergency vehicles grew louder. Many sirens, their mingled screams like those of a panicked herd rushing from a pack of predators. The double doors at trauma admitting swept open as she barely slowed enough to clear them. Dec turned from the central station at the far end of the wide hallway, saw her coming, and strode toward her.
“What is it?” Honor said, barely catching her breath. She’d faced mass trauma alerts before, and every one was different. And every one brought tragedy—unless she and her staff were prepared, and maybe a little lucky. “I was almost home when I got the alert.”
“We don’t have much in the way of details,” Dec said. “Something about an incident at a concert downtown. All we’re hearing is multiple injuries at this point. We’re expecting at least a couple dozen, the extent—”
Honor lost the words beneath the roaring in her ears. She swayed, suddenly dizzy, and spots danced before her eyes.
“Honor. Honor?” Dec’s worried voice cut through the screaming inside her head.
Honor struggled to focus, looked around, and saw that Dec had drawn her out of the main corridor where nurses, PAs, residents, and techs from every area of care raced back and forth, preparing rooms, organizing emergency equipment. A dozen gurneys already lined the length of the hallway, all the way to the entrance—sentinels waiting to collect the casualties as they arrived.
“I…” Honor swallowed around the terror in her throat. “Dec, Arly’s at that concert. I…oh my God.”
“I’ll find Quinn,” Dec said. “Let’s go to your office.”
“No, no.” Honor took a deep breath, forcing down the nausea and panic. “I can’t sit somewhere and wait. And there’s work to do.” She willed her mind to work, and despite her soul-searing panic, she planned. “I need to call her. Just let me call her. Once I know she’s all right, everything will be fine. Fine.”
“Right, go ahead. I’ll be just down the hall getting the residents assigned.” Dec squeezed her arm. “Let me handle this part, Honor.”
“Of course.” Honor pulled out her phone as Dec walked away, already talking on hers.
She checked first for a text—nothing. She called Arly, and the message went to voice mail. She called back instantly, knowing that sometimes Arly would catch her call the second time around. Arly didn’t answer the third time, or the fourth. Honor leaned against the wall and closed her eyes. Arly would be fine. There were thousands of people there, and it had to be chaotic just trying to get people to safety, let alone clear the roads for their vehicles. The phone lines had to be jammed, or down altogether. It would take Arly a while to call. No word only meant Arly couldn’t get through. But she would. Of course she would.
“Honor,” Quinn said and pulled Honor into her arms.
Honor pressed her face to Quinn’s shoulder. “I can’t reach her.”
Quinn drew her down the hall away from the bustle of equipment carts rolling by and people calling instructions. “I know, I can’t either. But she’ll call as soon as she can.”
“Yes, I know. I know.” She stopped abruptly and looked into Quinn’s eyes. “We have to take care of the patients coming in. Raymond will bring them home, or Arly’ll come here. She’ll know to do that. Or she’ll call us. And if she doesn’t, we’ll go find her.”
Quinn took her hands, as solid and steady as she had ever been. “We will. Can you work?”
“Yes,” Honor said, the strength returning to her body as she focused on the next step. She would take that step, and the next, and the next—until everyone who needed her was taken care of. “Arly knows where we are, and there’s nothing we can do right now to find her. We’ll do what we do, what we have to do here, and then…” She straightened. “Then we’ll know what to do next.”
“Where’s Jack?” Quinn said.
“I called Phyllis from the car on my way back here. She’ll keep him there with her as long as needed.”
“I’ll call her,” Quinn said, “and get her trying to trace Arly’s phone. She can call other kids’ families too. She knows them all. Someone will have heard.”
“Yes, yes.” Honor grasped Quinn’s arm. “And after that, we’ll need to contact the other ERs.”
Quinn nodded. “If we don’t hear. But we will. I’m going to be in the OR. You call me the minute you hear from her. No matter what, you call me.”
Honor cupped her jaw, drawing strength from the certainty in her eyes. “I will. I love you.”
Quinn kissed her. “I love you too. She’s going to be all right. She’s the smartest kid I know.”
Honor heard the catch in Quinn’s throat and loved her for it. She put her arms around her. “It’s going to be all right.”
For an instant, Quinn clung to her as Honor had clung to her a few minutes before. Then Quinn stepped back and smiled that smile that said everything Honor needed to hear. “I’ll see you as soon as I can.”
Honor found Dec, and between them, they organized the ER and the trauma unit as the first of the patients rolled through the door. Then she got to work.
* * *
Emmett stood in the center of trauma admitting, directing residents as they raced in. She signaled to Dani and Ren when they arrived. “Dani, run trauma one. Ren, you’ve got trauma two. Here’s the drill—time is everything—we can’t let them get backlogged. Once a patient is stabilized, hand them off to your junior resident to take them the rest of the way. If you need to clear anything with an attending, grab one or one of the staff PAs. Keep the patients moving through as quickly as you can. We don’t know how many we’re gonna get, but what I’m hearing right now, it’s at least twenty. Smoke inhalation, crush injuries, the usual blunt trauma stuff.”
“What about coverage for procedures?” Dani said.
Emmett shook her head. “The seniors are acting junior attendings tonight—you supervise the juniors, take over where needed. If you run into trouble, look for staff.” She shrugged. “But don’t count on that.”
“Right,” Dani said flatly.
Ren glanced at Dani, her heart pounding unnaturally fast. She’d handled traumas before, but never what was coming. Patients with multiple traumas, all arriving at once, who would have to be triaged within minutes and stabilized enough so their noncritical injuries could be treated later. And with that many patients, the staff would be fully involved, and her call would be the final call.
“Okay then,” Dani said. “I’ll take Sadie and Roberto.”
“Where’s Zoey?” Ren said.
“She’s running an ER room. You’re going to have to work with one of the juniors. Sorry.”
“Yes, fine,” Ren said and, catching sight of Jez, signaled her over. “Trauma two. Let’s go.”
Jez nodded, almost running to keep up with Ren. “What are we doing?”
“Whatever we have to,” Ren said.
And then there was no more time to talk. Or prepare.
The patients came through the doors in a steady stream, some of them in wheelchairs pushed by staff, but others by friends who had somehow gotten them to the hospital. Some walked in under their own power, and some, the critical ones, arrived on gurneys with EMTs and paramedics running along beside them, calling out the status to whichever staff hurried along beside them. As soon as the staff took over, the medics raced back outside or up to the helo pad to head back out for another run. The medivac helos landed continuously, bringing the critical-level ones to the trauma unit. Smoke inhalation, multiple fractures, crush injuries, head injuries, spinal damage. The signs of a crowd out of control.
Ren lost track of time, moving from bed to bed, assisting residents putting in chest tubes, applying splints, ordering X-rays, starting bloods, grabbing the neuro fellows or the CT fellows or whoever she could find to take the worst cases to the OR. When the arrival of new patients had slowed to the point that some of the residents had no new patients to see, she finally stepped back, drew a deep breath, and took in the evidence of chaos throughout trauma admitting. Empty equipment carts pushed haphazardly up against the walls, gurneys with rumpled sheets hanging askew, scattered bandage wrappers and intravenous lines and IV bags, a crash cart with empty drawers standing open outside room three. All evidence of the many patients they had evaluated, treated, and stabilized in the last—she glanced at the big clock on the wall—fifty-two minutes. Fifty-two minutes that felt like fifty-two hours.
Dani came out of a room down the hall, saw her, and walked to meet her. Her cover gown was bloodstained, and her usual brisk step slowed.
“Are your rooms pretty clear?” Dani said.
“Yes,” she said breathlessly. “Jez has it under control.”
“Good. Emmett just called. They need us in the OR.”
Ren pulled off her cover gown and grabbed a clean one. “Yes, right.”
They rode up in the elevator together, barely speaking.
“I have no idea if I made all the right calls,” Ren finally said.
“Did anyone die?”
“No, at least not down there.”
“Then you made the right calls,” Dani said. “They need somebody on the ruptured aortic aneurysm. You want to take it?”
Ren stared at her. “You have to ask?”
Dani grinned and looked like her old self. “Just checking. I’ll take the exploratory lap. I think it’s gonna be a splenectomy.”
“I’ll see you later?” Ren said.
“You better.”
* * *
Trauma admitting, 3:00 a.m.
As soon as the splenectomy was off the table, Quinn tossed her gown and gloves into the bin and raced back down to the emergency room. She saw Dec first. “Where’s Honor? Has she heard anything?”
Dec shook her head. “I don’t think so. She’s calling the other hospitals right now, but it’s a mess. We don’t even have IDs on half the kids we’ve admitted here tonight.”
Quinn ran a hand through her hair. “I’m not even sure where to start.”
“You start by not going anywhere,” Dec said. “Arly’ll call or she’ll come here or we’ll all work the phones and call every ER in the city until we find her. But the chances are she’s okay.”
“I don’t believe in chances,” Quinn said. “I gotta find—”
“Quinn!”
At the sound of her name, Quinn spun around, and for an instant she was almost afraid she was dreaming. Arly ran toward her, her clothes disheveled and grimy, but moving under her own power.
“Get Honor.” Quinn catapulted forward and scooped Arly into her arms, trying not to crush her to her chest the way she wanted. “Are you hurt?”
“Arly,” Honor called and suddenly the three of them were entwined.
“I’m fine I’m fine I’m fine,” Arly chanted. “But Janie’s hurt. They took her in the ambulance, and I went too. Her arm is broken, I think. They’re bringing her, Mom.” She shivered. “There were so many people. She fell but she never let go of my hand.”
“I’ll take care of her, honey.” Honor stepped back and grasped Arly’s shoulders, studying her from the top of her head to her toes. “Why are you barefoot?”
Arly stared down at her feet. “I don’t know. I lost my shoes, I guess?” She looked back up at Honor and burst into tears.
Honor wrapped her up and looked at Quinn. “I’ve got her. Can you find Janie?”
“On it. I’ll see to her and then find out about the rest of the kids. It’ll be all right.” Quinn kissed Arly’s head and then Honor. “We’re together. We’ll always be all right.”
* * *
OR lounge, PMC, post-mass-casualty alert
Later turned out to be three in the morning before they’d finished repairing the ruptured aorta in a seventeen-year-old who had shoe marks on his chest from where someone had run over him. His ribs were fractured, as was his sternum, and he’d nearly bled out from a traumatic tear in his aorta. Ren scrubbed with Harkins, who remembered her from the surgery she’d done with him on the ICU patient.
“You’re planning on CT, right?” he said as they placed the sternal wires at the end of the case.
“Yes.” She twisted them down with the wire twister, and he cut them one by one.
“Not planning on wasting your life in the lab, are you?”
She glanced up and couldn’t read in his eyes if he was kidding or not. “I don’t think it’s a waste, but no, I plan on primarily clinical surgery. But I hope to oversee a lab at some point.”
Harkins laughed. “Smart answer. I would be very positively inclined should you decide to stay here.”
Ren smiled. “Thank you for saying that.”
“Is that a yes?”
“I’m not sure I’m supposed to say anything about that.”
He shrugged. “I’m going to consider that a yes. If for some reason something makes you want to change your mind, come see me first.”
“Thank you. I will.”
When she got the patient settled, Ren returned to the OR lounge to wait for Dani. The last she’d heard, they were finishing up in her room too. She looked up at the sound of footsteps, and Zoey came in.
Zoey flopped down on the far end of the sofa and said, “Nobody tells you it’s gonna be like that.”
“I thought it was just me,” Ren said.
Zoey gave her a look. “You mean the panic? The pee in your pants terror?”
Ren laughed. “Well, that too. But I kind of meant how fast it is, how little time there is to make a decision, and how many of them there might be. But everyone was amazing. The juniors handled it, though—Jez especially. She’s really good.”
“She says the same thing about you,” Zoey said.
“Really.” Ren smiled, the praise coming from a resident meaning more than the invitation she’d just had from Harkins. “That’s good.”
“What’s good,” Dani said, squeezing in between Zoey and Ren on the sofa. “Other than, you know, an amazing incredible night like this…and, you know, an awesome girlfriend.”
Zoey groaned. “Don’t even go there.”
Dani slid her hand over Ren’s where it rested on her thigh. “Case go okay?”
“Good,” Ren said. “Harkins sort of said I should stay here for CT.”
“That’s my girl. Awesome in every way.”
Zoey got up. “Okay, I’m leaving before this gets any heavier.” She paused at the door. “Are you two planning on coming back together tonight? Because if you are, I’ll find Dec and stay with her.”
Ren answered before Dani could. “Yes. But we don’t make that much noise.”
Zoey burst out laughing. “I’m sure I’ll have plenty of opportunity to find out. But I’m feeling a little noisy myself, so I’ll go find Dec.” With a wave she disappeared.
“I really like her,” Ren said.
“Yeah, me too. Let’s check downstairs in the ER,” Dani said. “Then let’s get out of here. Because that sounded like a promise to me.”
Ren held Dani’s hand as they rose. “It is. And I like what you said, about me being your girl.”
“I was serious,” Dani said quietly.
“I know. Me too. And you know what you said earlier, about knowing when you know?”
Dani drew a breath. “Yeah?”
Ren kissed her. “I know.”