Chapter Text
I bet you all felt so cool watching that septic waitress and knowing exactly what a code sepsis was! Hope you enjoy this chapter 🥰
Medical Guide
MAP: Mean Arterial Pressure. The pressure in your arteries is higher when the heart is pumping (systolic pressure) and lower when the heart is between beats (diastolic pressure). The MAP is the average of the two values. A MAP of 65 is generally considered the minimum value for the body to circulate blood properly.
Levophed: a drug that causes blood vessels to constrict, which then increases blood pressure.
Emphysematous Pyelonephritis: A kidney infection severe enough that the bacteria start producing gas inside the kidney itself, breaking down the tissue as they go. People with diabetes are at much higher risk of this infection.
Ch 2
Getting from the bed to the CT table was bad enough.
Lying flat on the hard table, arms positioned above her head, was even worse.
Her fingers laced loosely around the plastic bar they'd handed her. The pain in her back was throbbing, burning brighter with each heavy beat of her heart.
The machine hummed as the table slid her into the bore.
"Stay nice and still," the tech called gently before stepping out and closing the door.
She stared at the white-gray plastic inches above her face.
Contrast burned up her arm, hot and metallic. It bloomed across her abdomen and down into her pelvis, layering warmth over the pain in a way that felt almost mocking.
She tried to focus on breathing.
On the mechanical whir of the gantry.
On not moving.
Her shoulders trembled from holding her arms overhead. The stretch dragged across her flank and into her spine, pulling the barbed wire around her kidney taut.
Her fingers twitched.
Her elbows bent despite herself.
Her arms lowered just an inch to ease the tearing pull across her side. She corrected herself quickly, straightening her elbows again.
The pain flared hotter.
Her breath shattered.
It was too much.
A strained, involuntary sound tore from her throat.
"I—I can't—"
Her hand flew down to her side. Her knees bent instinctively.
The moment she rolled, desperate to take the pressure off her back, the scanner alarmed.
A creeping rush of heat flushed down her neck, followed by a hollow feeling behind her eyes. Something worse than dizzy—like the air had thinned, leaving her head starved for a full breath.
Her breathing deepened without her permission.
The room went a fraction dimmer at the edges.
Robby was mid-chart when the overhead crackled.
"Staff assist, CT. Staff assist, CT."
He was out of his chair before the second announcement finished.
Dana looked up from the desk and found him already moving.
She fell into step without a word.
They covered the hallway in under a minute, badge-tapping through the double doors at a pace just short of running. The CT suite came into view.
They could just make out Princess's voice as they neared the door:
"Cycle another pressure."
Robby pushed past two techs crowding the doorway.
Trinity was curled on her side on the CT table, one arm tucked hard against her back. Princess was at her side, one hand braced on her shoulder, the other pressed to her wrist. The transport monitor was screaming.
"What happened?" Robby demanded.
"Her BP dropped in the scanner," Princess said, voice tight but controlled. "It's not coming back up."
Trinity's eyes were open but vacant.
"Trinity." He tilted his head into her line of sight. "Hey. Talk to me."
Her gaze drifted to him. Slow. Like it cost something.
"Gonna pass out," she murmured.
"Okay, easy," Robby said, voice low and steady. "How much fluid do we have in?"
"Liter and a half," Princess replied. "MAP's 58."
"Start levophed. Titrate to a MAP of 65. Pressure bag the LR. Have vasopressin ready if she doesn't stabilize."
Dana ran for the med room.
"What access do we have?"
"Eighteens in the left and right AC."
"That'll do for now."
"'S dark," Trinity interjected quietly.
"I know," Robby said, hand coming to rest on her shoulder. "You're going to feel a lot better once we get your pressure up. Hang on."
"BP's 64 over 40," Princess said. "Heart rate 142."
"I think…" Her voice came out small and slurred. "I think I'm dying."
The room stilled for a fraction of a second before Robby launched back into motion.
"No. No, you're not. Stay right here." His eyes never left her face. "Where's that levophed?!"
Dana burst back into the room.
"Got it!"
Princess loaded it into the waiting pump as Dana connected the line.
"Start at .06," Robby directed.
Trinity's hand fell from where it had been pressed to her back.
Robby caught it before it dropped off the table and tucked it next to her.
Her fingers were cold.
"You're alright," he said, quieter now. "The medication's going in. Give it a minute."
She didn't answer.
Her eyes were still open but they weren't tracking anymore.
"Santos." He squeezed her hand once, hard. "I need you to say something."
A long pause.
"Fuck," she managed.
"I'll take it."
The pump ticked steadily.
Robby kept his fingers at her wrist, counting against the clock in his head.
"70 over 45," Princess said.
Moving in the right direction. Still not enough.
"Bump it to .08."
Princess adjusted the pump.
Trinity's eyes drifted shut. He pinched her trapezius between two fingers.
"Hey."
She flinched, cracking her eyes open with a displeased expression.
"Stay awake."
A low, unhappy sound came from somewhere in her chest.
"Complain all you want with your eyes open."
The pump ticked on.
"84 over 56."
He watched her face. A bit of color had returned to her cheeks, her breathing no longer shallow.
"Hold there," he said. "Let's see if it stays."
Twenty seconds.
"Still 84," Princess said.
"Good." He leaned down, getting back into Trinity's eyeline. "Trinity."
Her eyes found him with something closer to focus.
"You know where you are?"
A pause.
"CT."
"Good. What day of the week is it?"
"Monday."
"Pressure's holding at 86 over 58," Princess said.
"Okay." He straightened. "We'll see how much of the scan we got, but we're definitely done here. Let's get her back to the ED."
He looked back down at Trinity. She was watching him now with clarity in her gaze, the vacancy burned off enough to leave just exhaustion behind.
"That… sucked…" she breathed.
He huffed an incredulous laugh.
"I bet it did."
The hallway outside CT didn't feel so long on the way back.
Robby walked alongside the gurney, one hand loose on the rail, eyes moving between Trinity and the transport monitor in the practiced rhythm of someone who'd done this a thousand times. The levophed pump clicked steadily on its pole. Princess navigated the corners without being asked.
The familiar sounds of the ED filtered in before the doors did. Monitors, voices, the distant clatter of a supply cart.
By the time they rolled her back into the bay, her pressure had climbed to 94 over 62 and held there like it intended to stay. Trinity no longer had to white-knuckle consciousness.
The transport monitor got swapped for the wall unit. Lines were untangled and the levophed drip transferred without interruption.
Robby checked the numbers once, then again.
Once he was satisfied, he pulled up a stool and sat down, opening her chart on the computer.
Trinity had her eyes closed, one arm folded beneath her head. Her breathing had evened out, deep and slow, somewhere in the territory of almost-sleep.
Nausea had returned to keep her awake, swelling and rolling in her stomach.
"Um—" she started, finding her voice.
Every head whipped toward her.
"I need more Zofran."
In an instant, a basin was under her chin and a hand landed on her shoulder to keep her on her side.
The speed was kind of endearing.
"I'm good," she almost smiled. "I just—more Zofran."
Dana hesitantly set the basin down and Robby slowly removed his hand from her shoulder.
"Push another four milligrams IV," he said.
The Zofran started to work within minutes and Trinity was confident enough to push the pink basin out of sight.
The phone on the wall rang. Dana answered.
"ED. Yep, I have him here." She switched the call to speaker. "Go ahead."
"I have a critical lab value for Trinity Santos—lactate's 4.8."
"Got it, thanks."
Dana hung up.
Robby gave Trinity a pointed look. She resisted the urge to roll her eyes.
"Spare me."
"Eight fucking days," he muttered, shaking his head.
"Did they get enough of the CT?" she asked.
"Not sure yet."
"You got most of it," Princess said. "Three quarters, maybe?"
"Ugh." She pinched the bridge of her nose. "Only annoying patients freak out in CT."
"I don't think septic shock counts as freaking out," Princess replied.
"Same thing," Trinity shrugged.
"It really isn't."
Perlah stepped up with the glucometer and took Trinity's finger.
"Tapos ka na ba sa pananakot mo sa'min?" she asked pointedly.
Are you done scaring us?
Princess threw her hands up lightly. "Maawa ka naman."
Have mercy.
"Ano bang pinagsasabi mo," Trinity replied.
I have no idea what you're referring to.
"Glucose is 210," Perlah told Robby.
"Good," he nodded. "Coming down nice and slow."
Trinity caught sight of Frank passing by the bay. He did a double take and stopped in his tracks.
He pushed through the door.
"What happened here?"
Trinity crossed her arms.
"Don't ask," she muttered.
He scanned the medications hanging above her.
"Zosyn, levophed, and insulin," he read. "Sounds like you're the proud new owner of an ICU bed."
"I hate you."
"Yeah, I've gathered that," he replied easily. He stepped closer to the foot of the bed, posture shifting into something softer. "How're you feeling?"
"Like my kidney is trying to off me."
"Pyelo," he nodded thoughtfully. "Could've guessed that. You could barely stand up straight Friday."
"God, you and Robby," she scowled. "Be less observant or something."
Frank turned to Robby.
"She's jealous of our superior clinical instincts."
Robby just smirked, shaking his head. "Still waiting on CT to come back, but pyelo is a promising guess. Hopefully they got what they needed with the limited study."
"Limited study?" Frank repeated. He looked at Trinity, who resolutely averted her eyes. "Did you bail on CT?"
"Maybe."
"Oh man." He chuckled. "Only annoying patients freak out in CT."
Trinity's eyes widened and shot to Princess.
"See?!"
Frank leaned a hip against the bed rail.
"Trying to steal my title as department black sheep?"
"Oh no," she said. "That one's yours." She leaned slightly closer, lowering her voice. "My drugs are prescribed."
His hand flew to his chest.
"Low blow, Santos. I'll blame the delirium."
"Yeah," Trinity agreed dryly. "I'm never this honest afebrile."
"Exactly," he nodded.
The phone on the wall rang again.
"ED," Dana answered. "He's here." She switched on the speakerphone. "Go ahead."
"Dr. Robinavitch?"
"Yep."
"Hi, it's Dr. Cooper in radiology. I have a critical result for Trinity Santos. There are small foci of gas within the left renal parenchyma—consistent with early emphysematous pyelonephritis."
The room went still.
Trinity groaned.
"Oh, you've got to be fucking shitting me."
"…Dr. Santos?" Cooper said.
Robby didn't look at her.
"No obstruction? No drainable collection?"
"No," Cooper replied. "No hydronephrosis. No drainable abscess. No perinephric extension. This looks early."
"Alright. Appreciate it."
"Feel better, Dr. Santos."
"Yeah," she muttered. "Working on it."
Dana hung up. The click of the receiver sounded louder than it should have.
A necrotizing infection.
Fuck.
Robby wasted no time.
"Page urology—I want them down here now. Repeat lactate and CMP. Strict I's and O's."
The room moved. Dana was back on the phone. Princess grabbed a gray and gold top tube. Perlah peeled open a phlebotomy kit.
Frank hadn't moved from the foot of the bed.
Trinity stared at the wall across from her.
The silence stretched just long enough to mean something—long enough to make her skin feel too tight.
"You've really outdone yourself this time," Frank said gently.
"Yeah," she replied, the word small.
"Take care of yourself, okay?" He pushed off the rail. "I'm here if you need me."
She just nodded, not trusting her voice.
He slipped out through the curtain.
Robby pulled a stool up to her bedside, sitting down and crossing his forearms on the rail.
"We caught this early," he said quietly. "We're going to stay ahead of it."
She swallowed hard. Her throat tightened, eyes starting to burn.
"This is my fault," she whispered.
"No," he said immediately. "It's not. I wish we could have treated this sooner—but people get sick, Trinity. We see it every day. This is not your fault."
"I've been trying," she replied, barely getting the words out.
She'd been so careful—calculating corrections, eating when she should. She'd even started using an alcohol swab before her injections. She'd told Dana when she felt low. She'd been seeing the trauma counselor every week.
She'd been letting people in.
"I know," he said. "I see it. Everyone sees it. You're kicking ass, Santos."
She breathed out slowly, a twitch of a smile touching her cheek.
"Never doubt that."
He stayed a few minutes longer, until the urology resident appeared at the curtain and the room filled back up with voices and movement.
The ICU bed was ready by the time urology signed off. Her pressure was steady. The repeat lactate was pending.
She was as stable as they could hope for.
The transport team materialized with their usual efficient chaos—lines checked, pumps transferred, monitor swapped back to portable.
Robby stood off to the side while they got organized around her.
Trinity watched the ceiling get replaced by the hallway lights as the bed started moving.
"Hey," Robby said, walking alongside.
She looked at him.
"Behave yourself up there."
She gave him the most unconvincing look she could manage.
"Always."
"Trinity."
The corner of her mouth lifted slightly.
"I'll be fine," she said. Quietly. Like she almost meant it.
He held her gaze for one more second.
Then he stepped back and let the transport team take her.
He watched the gurney until it disappeared around the corner.